Provider Demographics
NPI:1992883128
Name:CARL, JUDITH L (PHD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:L
Last Name:CARL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 TEJON PLACE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-1204
Mailing Address - Country:US
Mailing Address - Phone:310-377-1198
Mailing Address - Fax:310-544-4620
Practice Address - Street 1:300 TEJON PLACE
Practice Address - Street 2:SUITE 5
Practice Address - City:PALOS VERDES ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-1204
Practice Address - Country:US
Practice Address - Phone:310-377-1198
Practice Address - Fax:310-544-4620
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10304103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical