Healthcare Provider Details

I. General information

NPI: 1154377984
Provider Name (Legal Business Name): JUDITH DAVIDSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 LOWER CMNS
WOODBURY CT
06798-3219
US

IV. Provider business mailing address

10 LOWER CMNS
WOODBURY CT
06798-3219
US

V. Phone/Fax

Practice location:
  • Phone: 203-800-8614
  • Fax:
Mailing address:
  • Phone: 203-800-8614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number001649
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: