Judith Davidson, PHD
Individual provider Active NPI Psychologist · Woodbury, CT
NPI 1154377984 · NPPES record last updated Nov 1, 2024
Key facts
- NPI
- 1154377984
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 001649 (CT)
- Practice address
- 10 Lower CMNS
Woodbury, CT 06798-3219 - Phone
- (203) 800-8614
- NPI assigned
- May 25, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 1989
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
10 Lower CMNS
Woodbury, CT 06798-3219
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20061212000647 | CT | Practitioner - Clinical Psychologist | 0244239622 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1649 | CT | MD | Behavioral Analyst |
| 001649 | CT | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medoptions Behavioral Health Assoc, LLC | Past | Accepting new patients | |
| CPS, LLC (Consultant Psychiatric Services) | Past | Accepting new patients | |
| Shoreline Psychiatry of Western Connecticut, LLC | Past |
Accepting new patients | |
| CT Resource Group LLC | Psychologist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 001649 | CT | Yes |
Addresses
Primary practice location
10 Lower CMNS
Woodbury, CT 06798-3219
Mailing address
10 Lower CMNS
Woodbury, CT 06798-3219
Phone (203) 800-8614
Other providers in Woodbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 1, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.