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General NPI Number Information
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NPI Number | 1619188208
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Entity Type | Individual
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Provider Name | JUDITH SUE DIMASSA MFT
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Gender | Female
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 18040 SHERMAN WAY
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City | RESEDA
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State | CA
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Zip | 91335-4631
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Country | US
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Telephone | 818-758-1281
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Fax |
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Provider Business Mailing Address
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Address Line | 14130 HARTSOOK ST
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-1115
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Country | US
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Telephone | 818-990-1771
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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 | MFT27124
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License Number State | CA
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