Provider Demographics
NPI:1861529166
Name:HUDSON, ROBERT W (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:HUDSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3227 CLARIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-3607
Mailing Address - Country:US
Mailing Address - Phone:916-267-0238
Mailing Address - Fax:
Practice Address - Street 1:4144 WINDING WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841
Practice Address - Country:US
Practice Address - Phone:916-267-0238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15746103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL157461Medicare ID - Type Unspecified