Provider Demographics
NPI:1306017868
Name:DUDLEY, CHENELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:CHENELLE
Middle Name:
Last Name:DUDLEY
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 1:570 S AVENUE EAST BUILDING A
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:570 SOUTH AVENUE EAST
Practice Address - Street 2:BUILDING A, FLOOR 2
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016
Practice Address - Country:US
Practice Address - Phone:347-370-9635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055714001041C0700X
NY0762101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical