MEDICARE: DR. LINDA KUDLA PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1184016974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA KUDLA PSY.D.

Provider Business Mailing Address
First Line	:	247 57TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3308
Country	:	US
Telephone Number	:	929-265-0308
Fax Number	:

Provider Business Practice Location Address
First Line	:	247 57TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3308
Country	:	US
Telephone Number	:	929-265-0308
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2015
Last Update Date	:	09/02/2020

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