Provider Demographics
NPI:1225679145
Name:JUDSON, TIMOTHY ALAN
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ALAN
Last Name:JUDSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 W BROAD ST APT 5
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-1856
Mailing Address - Country:US
Mailing Address - Phone:484-636-9345
Mailing Address - Fax:
Practice Address - Street 1:920 E BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-1800
Practice Address - Country:US
Practice Address - Phone:610-388-9225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0222001041C0700X
PASW135513101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)