Provider Demographics
NPI:1255822243
Name:TEICHOLZ, JUDITH (EDD)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
Last Name:TEICHOLZ
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 BARBERRY RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-8032
Mailing Address - Country:US
Mailing Address - Phone:781-861-7569
Mailing Address - Fax:
Practice Address - Street 1:34 BARBERRY RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-8032
Practice Address - Country:US
Practice Address - Phone:781-861-7569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2015-PY-PR103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist