Provider Demographics
NPI:1538110341
Name:BRANDZEL, JUDITH BLACK (MSW LSW BCD)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:BLACK
Last Name:BRANDZEL
Suffix:
Gender:F
Credentials:MSW LSW BCD
Other - Prefix:MRS
Other - First Name:JUDITH
Other - Middle Name:L
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW CSW BCD
Mailing Address - Street 1:130 ALLENS CREEK OFFICE PK
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618
Mailing Address - Country:US
Mailing Address - Phone:585-244-2540
Mailing Address - Fax:585-271-1129
Practice Address - Street 1:130 ALLENS CREEK OFFICE PK
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618
Practice Address - Country:US
Practice Address - Phone:585-244-2540
Practice Address - Fax:585-271-1129
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0201571103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist