Provider Demographics
NPI:1194035972
Name:DULBERG, JUDITH L (PMHNP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:L
Last Name:DULBERG
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CRUM ELBOW RD
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-2852
Mailing Address - Country:US
Mailing Address - Phone:845-229-1020
Mailing Address - Fax:
Practice Address - Street 1:370 VIOLET AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1034
Practice Address - Country:US
Practice Address - Phone:845-471-1807
Practice Address - Fax:845-471-1815
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF404171363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY163W00000XMedicaid