MEDICARE: DR. JUDITH CLYMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	35S100339600	NJ
2	103TC0700X	Clinical Psychologist	35S100339600	NJ
3	103TP0814X	Psychoanalysis Psychologist	35S100339600	NJ

General Provider Information

NPI Number	:	1447436456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDITH CLYMAN

Provider Business Mailing Address
First Line	:	605 VALLEY RD
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07043-1459
Country	:	US
Telephone Number	:	973-509-1848
Fax Number	:	973-509-1807

Provider Business Practice Location Address
First Line	:	605 VALLEY RD
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07043-1459
Country	:	US
Telephone Number	:	973-509-1848
Fax Number	:	973-509-1807

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2008
Last Update Date	:	01/21/2008

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Directions to “ DR. JUDITH CLYMAN ” Practice Location

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