Provider Demographics
NPI:1285325977
Name:HUDSON, BRITTANI NICOLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:BRITTANI
Middle Name:NICOLE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 NW 107TH AVE APT 3204
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-4885
Mailing Address - Country:US
Mailing Address - Phone:310-415-6856
Mailing Address - Fax:
Practice Address - Street 1:4230 NW 107TH AVE APT 3204
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4885
Practice Address - Country:US
Practice Address - Phone:310-415-6856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY11873103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist