Provider Demographics
NPI:1386685543
Name:PIERSON, JUDITH ELLEN (EDD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ELLEN
Last Name:PIERSON
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HENLOPEN STA
Mailing Address - Street 2:UNIT 305A
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-3188
Mailing Address - Country:US
Mailing Address - Phone:302-227-6745
Mailing Address - Fax:
Practice Address - Street 1:715 REHOBOTH AVE
Practice Address - Street 2:#11
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-3100
Practice Address - Country:US
Practice Address - Phone:302-227-6745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7135103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5454616OtherAETNA HEALTH INSURANCE PL
MA87726OtherUNITED BEHAVIORAL HEALTH
MA232584OtherMANAGED HEALTH NETWORK
MA391192OtherMAGELLAN BEHAVIORAL HEALT
MAW05749OtherBLUE CROSS / BLUE SHIELD
MA232584OtherMANAGED HEALTH NETWORK