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General NPI Number Information
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NPI Number | 1730192543
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Entity Type | Individual
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Provider Name | JUDE M. TREDER-WOLFF LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 496 SMITHTOWN BYP SUITE 202
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City | SMITHTOWN
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State | NY
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Zip | 11787-5005
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Country | US
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Telephone | 631-366-4265
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Fax |
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Provider Business Mailing Address
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Address Line | 15 ONEIDA AVE
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City | SELDEN
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State | NY
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Zip | 11784-3715
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Country | US
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Telephone | 631-698-7536
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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 | R040325-1
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License Number State | NY
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