Healthcare Provider Details

I. General information

NPI: 1477991412
Provider Name (Legal Business Name): STEPHANIE BECKER WUDARSKI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE ALYSSA BECKER

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 01/08/2022
Certification Date: 01/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 BAILEY AVE 2ND FLOOR
BUFFALO NY
14215-2814
US

IV. Provider business mailing address

5700 BUNKERHILL ST APT 1703
PITTSBURGH PA
15206-1167
US

V. Phone/Fax

Practice location:
  • Phone: 716-831-1800
  • Fax: 716-831-1818
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW019967
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: