MEDICARE: JUDY ANN SLOBIG LCSW, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LC302560	DC

General Provider Information

NPI Number	:	1265171854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY ANN SLOBIG LCSW, PHD

Provider Business Mailing Address
First Line	:	1600 N SAN FERNANDO BLVD APT 331
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91504-4175
Country	:	US
Telephone Number	:	202-779-1415
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 N SAN FERNANDO BLVD APT 331
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91504-4175
Country	:	US
Telephone Number	:	202-779-1415
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2022
Last Update Date	:	06/01/2022

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