Provider Demographics
NPI:1275810392
Name:KUDLER, JODI (LCSW)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:KUDLER
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 1:78 LONE OAK DR
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1441
Mailing Address - Country:US
Mailing Address - Phone:631-707-4769
Mailing Address - Fax:
Practice Address - Street 1:78 LONE OAK DR
Practice Address - Street 2:
Practice Address - City:CENTERPORT
Practice Address - State:NY
Practice Address - Zip Code:11721-1441
Practice Address - Country:US
Practice Address - Phone:631-707-4769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO435791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical