Provider Demographics
NPI:1659468452
Name:JUDAH, RICHARD DENNIS (DED)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DENNIS
Last Name:JUDAH
Suffix:
Gender:M
Credentials:DED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 163
Mailing Address - Street 2:
Mailing Address - City:BOLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01740-0163
Mailing Address - Country:US
Mailing Address - Phone:866-249-0286
Mailing Address - Fax:866-249-0286
Practice Address - Street 1:#5 POND RD
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:MA
Practice Address - Zip Code:01451
Practice Address - Country:US
Practice Address - Phone:866-249-0286
Practice Address - Fax:866-249-0286
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2705103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1016360OtherFALLON-BEACON PROVIDER #
MA716422OtherTUFTS HEALTH PROVIDER #
MAW02822OtherBC/BS OF MA PROVIDER #
MAW02822OtherBC/BS OF MA PROVIDER #