Provider Demographics
NPI:1760576839
Name:HUDSON, BRADLEY OGDEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:OGDEN
Last Name:HUDSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 320, 500 & 600
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1577
Mailing Address - Country:US
Mailing Address - Phone:323-361-3814
Mailing Address - Fax:323-361-8350
Practice Address - Street 1:3250 WILSHIRE BLVD
Practice Address - Street 2:SUITES 320, 500 & 600
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1577
Practice Address - Country:US
Practice Address - Phone:323-361-3814
Practice Address - Fax:323-361-8350
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13124103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY131240Medicaid
CACP13124Medicare ID - Type Unspecified
CAR61845Medicare UPIN