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General NPI Number Information
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NPI Number | 1649890898
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Entity Type | Individual
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Provider Name | ANDREA POET HUDSON
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Gender | Female
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Dates
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Enumeration Date | 04/17/2020
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Last Update Date | 08/18/2022
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Provider Practice Location Address
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Address Line | 20525 DETROIT RD STE 10
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City | ROCKY RIVER
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State | OH
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Zip | 44116-2444
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Country | US
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Telephone | 216-800-6647
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Fax |
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Provider Business Mailing Address
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Address Line | 3191 GOLDENGATE AVE
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City | ROCKY RIVER
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State | OH
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Zip | 44116-3625
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Country | US
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Telephone | 814-285-2843
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | P.08077
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License Number State | OH
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