Basic Information
| Provider Information | |||||||||
| NPI: | 1255645750 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LICHTER | ||||||||
| FirstName: | JUDITH | ||||||||
| MiddleName: | MUSARO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 OAKTREE LN | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON STATION | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117464014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312714228 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 47 HUMPHREY DR | ||||||||
| Address2: | |||||||||
| City: | SYOSSET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117914022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169217171 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2010 | ||||||||
| LastUpdateDate: | 07/27/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | R033418-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041S0200X | NY | N | Behavioral Health & Social Service Providers | Social Worker | School |
No ID Information.