| NPI | 1811177173 |
|---|---|
| Former Name | JUDITH W FORMICA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD 08128) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C003836) |
| Enumeration Date | 2007-11-05 |
| Last Update Date | 2013-12-02 |