Provider Demographics
NPI:1821126632
Name:HUDSON, CAROLYN E (PH D)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:E
Last Name:HUDSON
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:DR
Other - First Name:CAROLYN
Other - Middle Name:ENGLEBERT
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PH D
Mailing Address - Street 1:5190 GOVERNOR DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-2847
Mailing Address - Country:US
Mailing Address - Phone:858-453-4344
Mailing Address - Fax:
Practice Address - Street 1:5190 GOVERNOR DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-2847
Practice Address - Country:US
Practice Address - Phone:858-453-4344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 13973103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist