Provider Demographics
NPI:1720483159
Name:CREIGHTON, JUDITH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
Last Name:CREIGHTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:BARRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:360 ESSEX ST STE 303
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-8566
Mailing Address - Country:US
Mailing Address - Phone:347-886-5875
Mailing Address - Fax:
Practice Address - Street 1:360 ESSEX ST STE 303
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-8566
Practice Address - Country:US
Practice Address - Phone:347-886-5875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020934103G00000X
NJNJDCATEMP-007454103TC0700X
NJ35SI00679700103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist