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General NPI Number Information
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NPI Number | 1225679145
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Entity Type | Individual
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Provider Name | TIMOTHY ALAN JUDSON
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Gender | Male
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Dates
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Enumeration Date | 10/02/2019
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 920 E BALTIMORE PIKE
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City | KENNETT SQUARE
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State | PA
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Zip | 19348-1800
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Country | US
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Telephone | 610-388-9225
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Fax |
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Provider Business Mailing Address
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Address Line | 369 W BROAD ST APT 5
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City | SOUDERTON
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State | PA
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Zip | 18964-1856
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Country | US
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Telephone | 484-636-9345
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW022200
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | SW135513
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License Number State | PA
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