Healthcare Provider Details

I. General information

NPI: 1568013258
Provider Name (Legal Business Name): ANASTASIA KATHERINE KUDLESS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 PERRY ST
CHESTER NJ
07930-3604
US

IV. Provider business mailing address

45 PERRY ST
CHESTER NJ
07930-3604
US

V. Phone/Fax

Practice location:
  • Phone: 908-529-0355
  • Fax:
Mailing address:
  • Phone: 908-529-0355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06274200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number110985
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: