Healthcare Provider Details

I. General information

NPI: 1982304531
Provider Name (Legal Business Name): JUDITH A. VERDUZCO, LICENSED CLINICAL SOCIAL WORKER PROF. CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2023
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3156 FOOTHILL BLVD STE C
LA CRESCENTA CA
91214-4261
US

IV. Provider business mailing address

3156 FOOTHILL BLVD STE C
LA CRESCENTA CA
91214-4261
US

V. Phone/Fax

Practice location:
  • Phone: 818-741-1221
  • Fax: 818-688-8020
Mailing address:
  • Phone: 818-741-1221
  • Fax: 818-688-8020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JUDITH ALCIRA VERDUZCO
Title or Position: CEO/ MENTAL HEALTH THERAPIST
Credential: LCSW
Phone: 818-741-1221