Healthcare Provider Details

I. General information

NPI: 1013084805
Provider Name (Legal Business Name): JUDITH KAY WILLETTS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUDI KAY WILLETTS PH.D

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 POLLY DRUMMOND HILL RD
NEWARK DE
19711-5703
US

IV. Provider business mailing address

8 POLLY DRUMMOND HILL RD
NEWARK DE
19711-5703
US

V. Phone/Fax

Practice location:
  • Phone: 302-738-6859
  • Fax: 302-368-5309
Mailing address:
  • Phone: 302-738-6859
  • Fax: 302-368-5309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberB1-0000352
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: