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General NPI Number Information
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NPI Number | 1336286178
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Entity Type | Individual
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Provider Name | JUDITH KAY NELSON PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2110 6TH ST
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City | BERKELEY
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State | CA
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Zip | 94710-2243
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Country | US
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Telephone | 510-540-7315
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Fax |
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Provider Business Mailing Address
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Address Line | 1335 KAINS AVE
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City | BERKELEY
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State | CA
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Zip | 94702-1015
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Country | US
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Telephone | 510-558-7436
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS 4620
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License Number State | CA
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