Provider Demographics
NPI:1114128782
Name:HUDACK, PATRICK MICHAEL (MFT)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:MICHAEL
Last Name:HUDACK
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 EMBARCADERO
Mailing Address - Street 2:SUITE 400
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-5334
Mailing Address - Country:US
Mailing Address - Phone:510-667-3946
Mailing Address - Fax:510-667-3903
Practice Address - Street 1:2000 EMBARCADERO
Practice Address - Street 2:SUITE 400
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-5334
Practice Address - Country:US
Practice Address - Phone:510-667-3946
Practice Address - Fax:510-667-3903
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 24961106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist