Provider Demographics
NPI:1114988326
Name:SCHUDER, JAY JUDE (DR AD)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:JUDE
Last Name:SCHUDER
Suffix:
Gender:M
Credentials:DR AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MARKET SQ
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2921
Mailing Address - Country:US
Mailing Address - Phone:860-878-9670
Mailing Address - Fax:860-878-6886
Practice Address - Street 1:100 MARKET SQ
Practice Address - Street 2:SUITE 5
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2921
Practice Address - Country:US
Practice Address - Phone:860-878-9670
Practice Address - Fax:860-878-6886
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000284101YA0400X
CT000462101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)