Provider Demographics
NPI:1518024314
Name:HEIDRICH, JUDITH A (MS, LMHC)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:HEIDRICH
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3471 N FEDERAL HWY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1019
Mailing Address - Country:US
Mailing Address - Phone:954-810-7878
Mailing Address - Fax:
Practice Address - Street 1:3471 N FEDERAL HWY
Practice Address - Street 2:SUITE 207
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1019
Practice Address - Country:US
Practice Address - Phone:954-810-7878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4909101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health