MEDICARE: DR. JUDITH GLICKMAN ZEVIN LCSW, PSY.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	LCS12553	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538162904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDITH GLICKMAN ZEVIN LCSW, PSY.D.

Provider Business Mailing Address
First Line	:	1151 DOVE ST
Second Line	:	STE 278
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2840
Country	:	US
Telephone Number	:	949-887-1897
Fax Number	:

Provider Business Practice Location Address
First Line	:	1151 DOVE ST
Second Line	:	STE 278
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2840
Country	:	US
Telephone Number	:	949-887-1897
Fax Number	:

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	01/07/2014

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