Provider Demographics
NPI:1013084805
Name:WILLETTS, JUDITH KAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:KAY
Last Name:WILLETTS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JUDI
Other - Middle Name:KAY
Other - Last Name:WILLETTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:8 POLLY DRUMMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-5703
Mailing Address - Country:US
Mailing Address - Phone:302-738-6859
Mailing Address - Fax:302-368-5309
Practice Address - Street 1:8 POLLY DRUMMOND HILL RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-5703
Practice Address - Country:US
Practice Address - Phone:302-738-6859
Practice Address - Fax:302-368-5309
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000352103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE246640OtherOPTIMUM CHOICE
DE61-94404OtherUBH PROVIDER NUMBER
DE51-0035PHDOtherBLUE CROSS ID#
DE159632OtherCOMPSYCH
DE2110783OtherCIGNA BEHVAIORAL HEALTH