Provider Demographics
NPI:1861549784
Name:YUEN, JUDITH V (PHD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:V
Last Name:YUEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2523 EL PORTAL DR
Mailing Address - Street 2:SUITE #103
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3305
Mailing Address - Country:US
Mailing Address - Phone:510-215-3700
Mailing Address - Fax:510-215-3720
Practice Address - Street 1:2523 EL PORTAL DR
Practice Address - Street 2:SUITE #103
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3305
Practice Address - Country:US
Practice Address - Phone:510-215-3700
Practice Address - Fax:510-215-3720
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical