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General NPI Number Information
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NPI Number | 1962438655
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Entity Type | Individual
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Provider Name | JUDITH B GOROVITZ PH.D.
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Gender | Female
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1200 E GENESEE ST
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City | SYRACUSE
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State | NY
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Zip | 13210-1968
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Country | US
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Telephone | 315-471-1339
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Fax | 315-445-2287
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Provider Business Mailing Address
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Address Line | 5069 PECK HILL RD
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City | JAMESVILLE
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State | NY
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Zip | 13078-9813
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Country | US
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Telephone | 315-445-2195
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Fax | 315-445-2287
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 8924
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License Number State | NY
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