Healthcare Provider Details

I. General information

NPI: 1942497961
Provider Name (Legal Business Name): RICHARD J CUDNEY BS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 STATE ROUTE 417 W
WELLSVILLE NY
14895-9332
US

IV. Provider business mailing address

4220 STATE ROUTE 417 W
WELLSVILLE NY
14895-9332
US

V. Phone/Fax

Practice location:
  • Phone: 585-593-1991
  • Fax: 585-593-7104
Mailing address:
  • Phone: 585-593-1991
  • Fax: 585-593-7104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: