Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | B1-0000352 | DE |
Y | 103T00000X | Psychologist | B1-0000352 | DE |
NPI | 1013084805 |
---|---|
Provider Name | Dr. Judith Kay Willetts |
First Address | Newark, DE 19711-5703 |
Second Address | Newark, DE 19711-5703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 09/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
159632 | COMPSYCH (01) | DE |
2110783 | CIGNA BEHVAIORAL HEALTH (01) | DE |
246640 | OPTIMUM CHOICE (01) | DE |
51-0035PHD | BLUE CROSS ID# (01) | DE |
61-94404 | UBH PROVIDER NUMBER (01) | DE |