Provider Demographics
NPI:1194994103
Name:ALLIK, JUDITH P (PHD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:P
Last Name:ALLIK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:VOLUNTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06384-2014
Mailing Address - Country:US
Mailing Address - Phone:860-376-2226
Mailing Address - Fax:860-376-2353
Practice Address - Street 1:70 LAUREL DR
Practice Address - Street 2:
Practice Address - City:VOLUNTOWN
Practice Address - State:CT
Practice Address - Zip Code:06384-2014
Practice Address - Country:US
Practice Address - Phone:860-376-2226
Practice Address - Fax:860-376-2353
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-23
Last Update Date:2008-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002491103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist