Provider Demographics
NPI:1366684532
Name:HUDSON, JUDITH A (PROV MHRT-C)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:HUDSON
Suffix:
Gender:F
Credentials:PROV MHRT-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EDGEMONT DR
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-2036
Mailing Address - Country:US
Mailing Address - Phone:207-764-3319
Mailing Address - Fax:207-768-5377
Practice Address - Street 1:1 EDGEMONT DR
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2036
Practice Address - Country:US
Practice Address - Phone:207-764-3319
Practice Address - Fax:207-768-5377
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME103850000Medicaid