Healthcare Provider Details

I. General information

NPI: 1245356112
Provider Name (Legal Business Name): JUDITH DEGRAZIA HARRINGTON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JUDITH DEGRAZIA WILLARD PHD, HSPP

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MURVIHILL RD
VALPARAISO IN
46383-5960
US

IV. Provider business mailing address

3000 MURVIHILL RD
VALPARAISO IN
46383-5960
US

V. Phone/Fax

Practice location:
  • Phone: 219-462-0246
  • Fax: 219-462-0226
Mailing address:
  • Phone: 219-462-0246
  • Fax: 219-462-0226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY0315
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1919
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number20042329A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: