Provider Demographics
NPI:1902991300
Name:DRACHMAN, JUDITH SUSAN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:SUSAN
Last Name:DRACHMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 DAHLIA DRIVE
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778
Mailing Address - Country:US
Mailing Address - Phone:508-358-3590
Mailing Address - Fax:
Practice Address - Street 1:220 NORTH MAIN STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760
Practice Address - Country:US
Practice Address - Phone:508-653-7830
Practice Address - Fax:508-647-1565
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1060761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP03815Medicare ID - Type Unspecified