Healthcare Provider Details

I. General information

NPI: 1154453975
Provider Name (Legal Business Name): NATALIE MARIE CUDDY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3941 68TH AVE N
PINELLAS PARK FL
33781-6136
US

IV. Provider business mailing address

3941 68TH AVE N
PINELLAS PARK FL
33781-6136
US

V. Phone/Fax

Practice location:
  • Phone: 727-831-0483
  • Fax:
Mailing address:
  • Phone: 727-433-6343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW8436
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: