MEDICARE: DR. JUDITH ANN UPSHAW LCADC, ED. D.

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	103K00000X	Behavior Analyst	LCA393	MD

General Provider Information

NPI Number	:	1447557095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDITH ANN UPSHAW LCADC, ED. D.

Provider Business Mailing Address
First Line	:	6002 43RD AVE.
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20781-1526
Country	:	US
Telephone Number	:	301-793-7391
Fax Number	:	301-891-4054

Provider Business Practice Location Address
First Line	:	6002 43RD AVE
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20781-1526
Country	:	US
Telephone Number	:	301-793-7391
Fax Number	:

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

Provider Enumeration Date	:	02/17/2011
Last Update Date	:	07/26/2022

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