1013084805 NPI number — DR. JUDITH KAY WILLETTS PH.D.

Table of content: DR. JUDITH KAY WILLETTS PH.D. (NPI 1013084805)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013084805 NPI number — DR. JUDITH KAY WILLETTS PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLETTS
Provider First Name:
JUDITH
Provider Middle Name:
KAY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLETTS
Provider Other First Name:
JUDI
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1013084805
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 POLLY DRUMMOND HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19711-5703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-738-6859
Provider Business Mailing Address Fax Number:
302-368-5309

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 POLLY DRUMMOND HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19711-5703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-738-6859
Provider Business Practice Location Address Fax Number:
302-368-5309
Provider Enumeration Date:
11/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  B1-0000352 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 246640 . This is a "OPTIMUM CHOICE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 61-94404 . This is a "UBH PROVIDER NUMBER" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 51-0035PHD . This is a "BLUE CROSS ID#" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 159632 . This is a "COMPSYCH" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 2110783 . This is a "CIGNA BEHVAIORAL HEALTH" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".