Provider Demographics
NPI:1730222985
Name:MYERS, JUDITH FRIEDWALD (LCSW)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:FRIEDWALD
Last Name:MYERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 EAST 12TH STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-7247
Mailing Address - Country:US
Mailing Address - Phone:212-353-8832
Mailing Address - Fax:212-353-8832
Practice Address - Street 1:321 EAST 12TH STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-7247
Practice Address - Country:US
Practice Address - Phone:212-353-8832
Practice Address - Fax:212-353-8832
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0152581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY085386OtherVALUE OPTIONS
NYN46213OtherEMPIRE BLUE CROSS BLUE SH
NYN46211Medicare ID - Type Unspecified