Healthcare Provider Details

I. General information

NPI: 1679188452
Provider Name (Legal Business Name): YUDY A. CID MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63A 8TH ST
HOBOKEN NJ
07030-5056
US

IV. Provider business mailing address

392 UNDERCLIFF AVE # 2
EDGEWATER NJ
07020-7251
US

V. Phone/Fax

Practice location:
  • Phone: 201-541-8100
  • Fax:
Mailing address:
  • Phone: 646-234-3160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: