Basic Information
| Provider Information | |||||||||
| NPI: | 1609004043 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAND | ||||||||
| FirstName: | JUDITH | ||||||||
| MiddleName: | ELLEN | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 93575 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850703575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803996100 | ||||||||
| FaxNumber: | 2105939863 | ||||||||
| Practice Location | |||||||||
| Address1: | 1845 S DOBSON RD STE 106 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852025662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804667010 | ||||||||
| FaxNumber: | 4802195254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2009 | ||||||||
| LastUpdateDate: | 08/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 4022 | AZ | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.