Healthcare Provider Details

I. General information

NPI: 1902577067
Provider Name (Legal Business Name): DEBORAH ANNE CUDDY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SYCAMORE CT
MONROE TOWNSHIP NJ
08831-4072
US

IV. Provider business mailing address

15 SYCAMORE CT
MONROE TOWNSHIP NJ
08831-4072
US

V. Phone/Fax

Practice location:
  • Phone: 732-991-1488
  • Fax:
Mailing address:
  • Phone: 908-616-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL04645500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: