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General NPI Number Information
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NPI Number | 1306017868
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Entity Type | Individual
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Provider Name | CHENELLE DUDLEY LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/12/2008
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 570 SOUTH AVENUE EAST BUILDING A, FLOOR 2
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City | CRANFORD
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State | NJ
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Zip | 07016
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Country | US
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Telephone | 347-370-9635
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Fax |
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Provider Business Mailing Address
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Address Line | 570 S AVENUE EAST BUILDING A FLOOR 2
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City | CRANFORD
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State | NJ
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Zip | 07016
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05571400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 076210
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9022
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License Number State | TN
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