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General NPI Number Information
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NPI Number | 1679784284
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Entity Type | Individual
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Provider Name | JUDITH DIANE MENDELSON LMFT
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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 | 711 E WALNUT ST SUITE 308
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City | PASADENA
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State | CA
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Zip | 91101-1676
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Country | US
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Telephone | 132-344-3305
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Fax |
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Provider Business Mailing Address
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Address Line | 10061 RIVERSIDE DR SUITE 270
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City | TOLUCA LAKE
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State | CA
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Zip | 91602-2560
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Country | US
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Telephone | 132-344-3355
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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 | MFT 27972
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License Number State | CA
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