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General NPI Number Information
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NPI Number | 1154669919
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Entity Type | Individual
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Provider Name | JUDITH WIDES M.A., M.ED
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Gender | Female
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Dates
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Enumeration Date | 01/29/2013
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Last Update Date | 01/29/2013
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Provider Practice Location Address
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Address Line | 3000 CONNECTICUT AVE NW SUITE 301
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City | WASHINGTON
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State | DC
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Zip | 20008-2509
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Country | US
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Telephone | 732-397-7544
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Fax |
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Provider Business Mailing Address
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Address Line | 4509 SANGAMORE RD APT.303
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City | BETHESDA
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State | MD
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Zip | 20816-2534
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT000157
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 37FI00167900
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License Number State | NJ
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