Provider Demographics
NPI:1043384712
Name:DUDA, DOROTHEA (LMHC)
Entity Type:Individual
Prefix:
First Name:DOROTHEA
Middle Name:
Last Name:DUDA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 MOUNT AUBURN ST
Mailing Address - Street 2:CLARK 1
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5502
Mailing Address - Country:US
Mailing Address - Phone:617-499-5054
Mailing Address - Fax:617-499-5465
Practice Address - Street 1:330 MOUNT AUBURN ST
Practice Address - Street 2:CLARK 1
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5502
Practice Address - Country:US
Practice Address - Phone:617-499-5054
Practice Address - Fax:617-499-5465
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA375101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM1199OtherBLUE CROSS