Healthcare Provider Details

I. General information

NPI: 1487105896
Provider Name (Legal Business Name): HUDSON HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 HARTING DRIVE
SALISBURY MD
21801
US

IV. Provider business mailing address

1505 EMERSON AVE
SALISBURY MD
21801-3220
US

V. Phone/Fax

Practice location:
  • Phone: 410-219-9000
  • Fax: 410-742-7048
Mailing address:
  • Phone: 410-219-9000
  • Fax: 410-742-7048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: LEAH EVANS
Title or Position: DIRECTOR OF COMPLIANCE
Credential:
Phone: 410-219-9000