=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104068527
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTIE L. HUDSON MSW, LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2009
-----------------------------------------------------
Last Update Date | 06/21/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 CEDAR BLVD STE 200
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15228-1330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-344-1989
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 122 SCHENLEY DR
-----------------------------------------------------
City | MC MURRAY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15317-3208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-344-1989
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CW016829
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------