Healthcare Provider Details

I. General information

NPI: 1255392783
Provider Name (Legal Business Name): JUDITH ANN POWER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2006
Last Update Date: 07/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 ROUTE 6A POB 302
WEST BARNSTABLE MA
02668-1142
US

IV. Provider business mailing address

27 WINDING COVE RD
MARSTONS MILLS MA
02648-1823
US

V. Phone/Fax

Practice location:
  • Phone: 508-362-6227
  • Fax: 508-362-6227
Mailing address:
  • Phone: 508-274-6465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4705
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: