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General NPI Number Information
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NPI Number | 1356687040
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Entity Type | Individual
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Provider Name | JONATHAN ADAM DUDEK PH.D.
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Gender | Male
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Dates
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Enumeration Date | 12/27/2012
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Last Update Date | 06/08/2015
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Provider Practice Location Address
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Address Line | 136 MILL ST
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City | PRINCETON
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State | ME
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Zip | 04668-3344
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Country | US
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Telephone | 207-796-5503
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Fax | 207-796-5528
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Provider Business Mailing Address
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Address Line | 136 MILL ST
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City | PRINCETON
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State | ME
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Zip | 04668-3344
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Country | US
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Telephone | 207-796-5503
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Fax | 207-796-5528
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS1103
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1052
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License Number State | NH
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