Provider Demographics
NPI:1962754432
Name:TAYLOR, JUDIA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JUDIA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 THOMAS AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4133
Mailing Address - Country:US
Mailing Address - Phone:347-744-0073
Mailing Address - Fax:
Practice Address - Street 1:561 COURT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-3804
Practice Address - Country:US
Practice Address - Phone:718-802-1111
Practice Address - Fax:718-780-7499
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY726648163W00000X
NY311096164W00000X
NY403617363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse