MEDICARE: DR. JUDITH KAY NELSON PH.D.

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	LCS 4620	CA

General Provider Information

NPI Number	:	1336286178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDITH KAY NELSON PH.D.

Provider Business Mailing Address
First Line	:	1335 KAINS AVE
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94702-1015
Country	:	US
Telephone Number	:	510-558-7436
Fax Number	:

Provider Business Practice Location Address
First Line	:	2110 6TH ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94710-2243
Country	:	US
Telephone Number	:	510-540-7315
Fax Number	:

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	07/08/2007

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