MEDICARE: CYNTHIA HUDSON LCSW

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	1041C0700X	Clinical Social Worker	58.007440	CT

General Provider Information

NPI Number	:	1770889214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA HUDSON LCSW

Provider Business Mailing Address
First Line	:	947 HIGH PATH RD
Second Line	:
City	:	WINDSOR
State	:	CT
Zip	:	06095-4128
Country	:	US
Telephone Number	:	860-461-3778
Fax Number	:

Provider Business Practice Location Address
First Line	:	947 HIGH PATH RD
Second Line	:
City	:	WINDSOR
State	:	CT
Zip	:	06095-4128
Country	:	US
Telephone Number	:	860-461-3778
Fax Number	:

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

Provider Enumeration Date	:	02/01/2011
Last Update Date	:	02/01/2011

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