Provider Demographics
NPI:1548513310
Name:DECARA, JUDA MARIE (MA,NCC,CCMHC)
Entity type:Individual
Prefix:MS
First Name:JUDA
Middle Name:MARIE
Last Name:DECARA
Suffix:
Gender:F
Credentials:MA,NCC,CCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:994 SEDGEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-8037
Mailing Address - Country:US
Mailing Address - Phone:813-767-7884
Mailing Address - Fax:321-574-5417
Practice Address - Street 1:4690 LIPSCOMB ST SE
Practice Address - Street 2:SUITE 6C
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905
Practice Address - Country:US
Practice Address - Phone:813-767-7884
Practice Address - Fax:321-574-5417
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH9063101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor