Healthcare Provider Details

I. General information

NPI: 1689123499
Provider Name (Legal Business Name): CUDA COUNSELING LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 N ANN ST
LITTLE FALLS NY
13365-1372
US

IV. Provider business mailing address

31 N ANN ST
LITTLE FALLS NY
13365-1378
US

V. Phone/Fax

Practice location:
  • Phone: 315-823-0022
  • Fax:
Mailing address:
  • Phone:
  • 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: ANDRE CUDA
Title or Position: OWNER
Credential: LCSW-R
Phone: 315-985-5950