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General NPI Number Information
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NPI Number | 1821813551
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Entity Type | Individual
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Provider Name | ANGELA VIVI HUDSON PSYD
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Gender | Female
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 55 ROUTE 35
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City | RED BANK
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State | NJ
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Zip | 07701-5918
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Country | US
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Telephone | 732-344-0727
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Fax |
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Provider Business Mailing Address
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Address Line | 125 OWENS AVE
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City | ATLANTIC HIGHLANDS
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State | NJ
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Zip | 07716-2504
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Country | US
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Telephone | 678-699-6077
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 35SI00762300
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License Number State | NJ
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