Provider Demographics
NPI:1053004903
Name:JUDD, TERRISHA (LMSW)
Entity type:Individual
Prefix:
First Name:TERRISHA
Middle Name:
Last Name:JUDD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 135
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-0135
Mailing Address - Country:US
Mailing Address - Phone:801-793-3749
Mailing Address - Fax:
Practice Address - Street 1:340 BROADWAY STE 7
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-3139
Practice Address - Country:US
Practice Address - Phone:888-454-3827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111885104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker