MEDICARE: DR. JENNIFER LUDROSKY PH.D.

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
1	103TC0700X	Clinical Psychologist	1111	WV
2	103TC0700X	Clinical Psychologist	PS016126	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	584398	OTHER	PA	VALUE BEHAVIORAL HEALTH
2	1925061	OTHER		BCBS
3	000000208894	OTHER	PA	UNISON KIDS
4	411613	OTHER	PA	UPMC

General Provider Information

NPI Number	:	1275659443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER LUDROSKY PH.D.

Provider Business Mailing Address
First Line	:	236 ELM DR
Second Line	:	SUITE 101
City	:	WAYNESBURG
State	:	PA
Zip	:	15370-8265
Country	:	US
Telephone Number	:	304-852-4032
Fax Number	:	304-627-0812

Provider Business Practice Location Address
First Line	:	236 ELM DR
Second Line	:
City	:	WAYNESBURG
State	:	PA
Zip	:	15370-8265
Country	:	US
Telephone Number	:	724-627-0926
Fax Number	:	724-627-0812

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	04/08/2022

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