Healthcare Provider Details

I. General information

NPI: 1700358249
Provider Name (Legal Business Name): GABRIELLE CUDEMO M.ED, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2018
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 KRESSON RD
CHERRY HILL NJ
08003-2590
US

IV. Provider business mailing address

1913 S WARNOCK ST
PHILADELPHIA PA
19148-2332
US

V. Phone/Fax

Practice location:
  • Phone: 856-424-2222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00800900
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC010686
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00800900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: