Healthcare Provider Details

I. General information

NPI: 1609112127
Provider Name (Legal Business Name): DEBRA O. NUDEL PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBRA ORLAND NUDEL PHD

II. Dates (important events)

Enumeration Date: 01/02/2013
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 WHITNEY AVE 201
NEW HAVEN CT
06511-3724
US

IV. Provider business mailing address

291 WHITNEY AVE 201
NEW HAVEN CT
06511-3724
US

V. Phone/Fax

Practice location:
  • Phone: 203-776-1488
  • Fax:
Mailing address:
  • Phone: 203-776-1488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number001713
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number001713
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: