Healthcare Provider Details

I. General information

NPI: 1083914782
Provider Name (Legal Business Name): PETER ANTHONY CUDNEY LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2010
Last Update Date: 10/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 AIRPORT RD
SOUTH BURLINGTON VT
05403-6432
US

IV. Provider business mailing address

30 AIRPORT RD
SOUTH BURLINGTON VT
05403-6432
US

V. Phone/Fax

Practice location:
  • Phone: 802-658-2441
  • Fax: 802-864-3857
Mailing address:
  • Phone: 802-658-2441
  • Fax: 802-864-3857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0058435
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: