Provider Demographics
NPI:1235900499
Name:SCUDIERI, KIMBERLEY
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:
Last Name:SCUDIERI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WOODPORT RD STE B
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-2628
Mailing Address - Country:US
Mailing Address - Phone:973-726-3772
Mailing Address - Fax:973-726-3775
Practice Address - Street 1:200 WOODPORT RD STE B
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-2628
Practice Address - Country:US
Practice Address - Phone:973-726-3772
Practice Address - Fax:973-726-3775
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC062962001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical