Healthcare Provider Details

I. General information

NPI: 1659989366
Provider Name (Legal Business Name): JOSHUA HUDSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 05/19/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DIRECTOR PSYCHOLOGICAL HEALTH 911TH AIRLIFT WING 2745 DEFENSE AVE
CORAOPOLIS PA
15108
US

IV. Provider business mailing address

2745 DEFENSE AVE
CORAOPOLIS PA
15108
US

V. Phone/Fax

Practice location:
  • Phone: 412-474-8813
  • Fax:
Mailing address:
  • Phone: 412-474-8813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW021986
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number112509
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW130668
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: