Basic Information
Provider Information
NPI: 1578502027
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHAPMAN
FirstName: JUDITH
MiddleName: BOCZKOWSKI
NamePrefix: DR.
NameSuffix:  
Credential: PH.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: BOCZKOWSKI
OtherFirstName: JUDITH
OtherMiddleName: ANNE
OtherNamePrefix: DR.
OtherNameSuffix:  
OtherCredential: PH.D.
OtherLastNameType: 1
Mailing Information
Address1: 3801 MIRANDA AVE
Address2: PSYCHOLOGY SERVICE -116B; DVA PALO ALTO HEALTHCARE SYST
City: PALO ALTO
State: CA
PostalCode: 943041207
CountryCode: US
TelephoneNumber: 6504935000
FaxNumber: 6508523445
Practice Location
Address1: 3801 MIRANDA AVE
Address2: PSYCHOLOGY SERVICE -116B; DVA PALO ALTO HEALTHCARE SYST
City: PALO ALTO
State: CA
PostalCode: 943041207
CountryCode: US
TelephoneNumber: 6504935000
FaxNumber: 6508523445
Other Information
ProviderEnumerationDate: 06/06/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700XPSY 10297CAY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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