Healthcare Provider Details

I. General information

NPI: 1154560357
Provider Name (Legal Business Name): WILLIAM JOHN HUDENKO PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 S MAIN ST STE 2B
HANOVER NH
03755-2075
US

IV. Provider business mailing address

19 ROCKY HILL LN
LYME NH
03768-3425
US

V. Phone/Fax

Practice location:
  • Phone: 603-277-9110
  • Fax:
Mailing address:
  • Phone: 607-737-1235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1227
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number017813-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: