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General NPI Number Information
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NPI Number | 1679309843
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Entity Type | Individual
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Provider Name | KRISTINA SULLIVAN-DUDEK LSW
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Gender | Female
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Dates
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Enumeration Date | 09/12/2024
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 108 SOMERDALE RD
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City | VOORHEES
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State | NJ
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Zip | 08043-1901
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Country | US
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Telephone | 856-428-5688
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Fax |
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Provider Business Mailing Address
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Address Line | 21 FOMALHAUT CT
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City | BLACKWOOD
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State | NJ
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Zip | 08012-2417
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SL06294100
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License Number State | NJ
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