Provider Demographics
NPI:1467170522
Name:ANDREA HUDSON, PSY.D. LLC
Entity Type:Organization
Organization Name:ANDREA HUDSON, PSY.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:POET
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:216-800-6647
Mailing Address - Street 1:20525 DETROIT RD STE 10
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-2444
Mailing Address - Country:US
Mailing Address - Phone:216-800-6647
Mailing Address - Fax:
Practice Address - Street 1:20525 DETROIT RD STE 10
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-2444
Practice Address - Country:US
Practice Address - Phone:216-800-6647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty