Basic Information
| Provider Information | |||||||||
| NPI: | 1194927624 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEKLE | ||||||||
| FirstName: | JUDITH | ||||||||
| MiddleName: | WARD | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8170 MCCAULEY WAY | ||||||||
| Address2: | |||||||||
| City: | LORTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220792970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036901426 | ||||||||
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| Practice Location | |||||||||
| Address1: | WALTER REED ARMY MEDICAL CTR | ||||||||
| Address2: | 6900 GEORGIA AVENUE NW | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 203070001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2023561012 | ||||||||
| FaxNumber: | 2027824922 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | SW 4756 | FL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.