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General NPI Number Information
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NPI Number | 1134336399
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Entity Type | Individual
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Provider Name | STACY DYAN HUDAK LMFT
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Gender | Female
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 02/09/2012
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Provider Practice Location Address
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Address Line | 437 PROSPECT AVE APT 3
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City | BROOKLYN
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State | NY
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Zip | 11215-5843
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Country | US
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Telephone | 917-745-6993
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Fax |
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Provider Business Mailing Address
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Address Line | 49 W 24TH ST SUITE 612
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City | NEW YORK
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State | NY
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Zip | 10010-3206
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Country | US
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Telephone | 917-745-6993
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 000908
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License Number State | NY
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