Provider Demographics
NPI:1053514620
Name:LAFFERTY, JUDITH ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ANN
Last Name:LAFFERTY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8621 BELLANCA AVE
Mailing Address - Street 2:STE. 215
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-4418
Mailing Address - Country:US
Mailing Address - Phone:310-641-1633
Mailing Address - Fax:310-216-7524
Practice Address - Street 1:8621 BELLANCA AVE
Practice Address - Street 2:STE. 215
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-4418
Practice Address - Country:US
Practice Address - Phone:310-641-1633
Practice Address - Fax:310-216-7524
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13723103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical