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NPI Code Detail

MEDICARE: CHRISTINE CUDDEBACK LCSW

MEDICARE: CHRISTINE CUDDEBACK LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker34008425AIN

General Provider Information

NPI Number : 1154966109
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINE CUDDEBACK LCSW
Provider Business Mailing Address
First Line : 7224 W 400 N
Second Line :
City : MICHIGAN CITY
State : IN
Zip : 46360-2903
Country : US
Telephone Number : 219-879-4621
Fax Number :
Provider Business Practice Location Address
First Line : 7224 W 400 N
Second Line :
City : MICHIGAN CITY
State : IN
Zip : 46360-2903
Country : US
Telephone Number : 219-879-4621
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2019
Last Update Date : 11/14/2019

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Directions to “ CHRISTINE CUDDEBACK LCSW” Practice Location

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