Provider Demographics
NPI:1124207063
Name:HUDAK, STEPHANIE A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:A
Last Name:HUDAK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3971 CORAL SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-2394
Mailing Address - Country:US
Mailing Address - Phone:617-823-1823
Mailing Address - Fax:
Practice Address - Street 1:2301 W SAMPLE RD
Practice Address - Street 2:BLDG 3 SUITE 4A
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33073-3081
Practice Address - Country:US
Practice Address - Phone:954-977-9775
Practice Address - Fax:954-977-9776
Is Sole Proprietor?:No
Enumeration Date:2007-10-28
Last Update Date:2007-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 87901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical