Provider Demographics
NPI:1235170796
Name:BLACK, JUDITH LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:LYNN
Last Name:BLACK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 NEWTOWN RD STE 300
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4805
Mailing Address - Country:US
Mailing Address - Phone:757-466-3336
Mailing Address - Fax:
Practice Address - Street 1:6330 NEWTOWN RD STE 300
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4805
Practice Address - Country:US
Practice Address - Phone:757-466-3336
Practice Address - Fax:757-455-5750
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002873103TC0700X
NC3019103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000829Medicaid
NC2117520OtherCIGNA
NC046WJOtherBLUE CROSS/BLUE SHIELD