MEDICARE: JUDITH L CARL PHD

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	103TC0700X	Clinical Psychologist	PSY10304	CA

General Provider Information

NPI Number	:	1992883128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH L CARL PHD

Provider Business Mailing Address
First Line	:	300 TEJON PLACE
Second Line	:	SUITE 5
City	:	PALOS VERDES ESTATES
State	:	CA
Zip	:	90274-1204
Country	:	US
Telephone Number	:	310-377-1198
Fax Number	:	310-544-4620

Provider Business Practice Location Address
First Line	:	300 TEJON PLACE
Second Line	:	SUITE 5
City	:	PALOS VERDES ESTATES
State	:	CA
Zip	:	90274-1204
Country	:	US
Telephone Number	:	310-377-1198
Fax Number	:	310-544-4620

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	10/24/2012

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