Healthcare Provider Details

I. General information

NPI: 1356547590
Provider Name (Legal Business Name): PATTI R DUDLEY LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 AIRPAX RD SUITE 300 BLDG-B
CAMBRIDGE MD
21613-6405
US

IV. Provider business mailing address

828 AIRPAX RD SUITE 300 BLDG-B
CAMBRIDGE MD
21613-6405
US

V. Phone/Fax

Practice location:
  • Phone: 410-228-3929
  • Fax: 410-228-3810
Mailing address:
  • Phone: 410-228-3929
  • Fax: 410-228-3810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberG05050
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: