Healthcare Provider Details

I. General information

NPI: 1720166036
Provider Name (Legal Business Name): ANNA MARIE HUDAK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 ROUTE 71 STE 2
SPRING LAKE NJ
07762-3223
US

IV. Provider business mailing address

1010 ROUTE 71 STE 2
SPRING LAKE NJ
07762-3223
US

V. Phone/Fax

Practice location:
  • Phone: 732-338-9242
  • Fax: 732-280-8514
Mailing address:
  • Phone: 732-338-9242
  • Fax: 732-280-8514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05304400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: