Healthcare Provider Details

I. General information

NPI: 1114521036
Provider Name (Legal Business Name): HARVEY HUDSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6623 SHAWNEE RD
MILFORD DE
19963-3445
US

IV. Provider business mailing address

6623 SHAWNEE RD
MILFORD DE
19963-3445
US

V. Phone/Fax

Practice location:
  • Phone: 302-573-1247
  • Fax:
Mailing address:
  • Phone: 302-573-1247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: