Provider Demographics
NPI:1013194786
Name:BUDZENSKI, CAROL A (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:A
Last Name:BUDZENSKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 197
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43566-0197
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:427 N DEFIANCE ST
Practice Address - Street 2:
Practice Address - City:STRYKER
Practice Address - State:OH
Practice Address - Zip Code:43557-9472
Practice Address - Country:US
Practice Address - Phone:419-682-1011
Practice Address - Fax:419-682-6097
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3855103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
02989OtherPARAMOUNT HEALTHCARE
OH000000128817OtherANTHEM BC/BS
OH0891085Medicaid
OH(BU)CP02755Medicare PIN
OHR71243Medicare UPIN