Provider Demographics
NPI:1053534149
Name:DUDLEY, CHARMA D (PHD)
Entity type:Individual
Prefix:DR
First Name:CHARMA
Middle Name:D
Last Name:DUDLEY
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 1:7325 GENA COURT
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15209
Mailing Address - Country:US
Mailing Address - Phone:412-821-1538
Mailing Address - Fax:412-821-1539
Practice Address - Street 1:733 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206
Practice Address - Country:US
Practice Address - Phone:412-821-1538
Practice Address - Fax:412-821-1539
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005366L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA739756OtherHIGHMARK BLUE CROSS BLUE