Healthcare Provider Details

I. General information

NPI: 1174546592
Provider Name (Legal Business Name): JUDITH LAWRENCE OUTTEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 JAYMOR RD STE B-150
SOUTHAMPTON PA
18966-3853
US

IV. Provider business mailing address

719 WASHINGTON LN
RYDAL PA
19046-2947
US

V. Phone/Fax

Practice location:
  • Phone: 215-947-8654
  • Fax:
Mailing address:
  • Phone: 602-319-8017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD210002656
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD444036
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: