Provider Demographics
NPI:1124597786
Name:HUDAK, DAWN M (EDD, LMHC, CCMHC)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:M
Last Name:HUDAK
Suffix:
Gender:F
Credentials:EDD, LMHC, CCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E HARTSDALE AVE APT 1C
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-3526
Mailing Address - Country:US
Mailing Address - Phone:914-562-8568
Mailing Address - Fax:
Practice Address - Street 1:150 E HARTSDALE AVE APT 1C
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-3526
Practice Address - Country:US
Practice Address - Phone:914-562-8568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12802101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health