Healthcare Provider Details

I. General information

NPI: 1184016974
Provider Name (Legal Business Name): LINDA KUDLA PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 57TH ST
BROOKLYN NY
11220-3308
US

IV. Provider business mailing address

247 57TH ST
BROOKLYN NY
11220-3308
US

V. Phone/Fax

Practice location:
  • Phone: 929-265-0308
  • Fax:
Mailing address:
  • Phone: 929-265-0308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: