Provider Demographics
NPI:1326624792
Name:SALLY JAMES RUDNICK, LCSW, PLLC
Entity Type:Organization
Organization Name:SALLY JAMES RUDNICK, LCSW, PLLC
Other - Org Name:SALLY RUDNICK, LCSW, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDNICK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-656-9439
Mailing Address - Street 1:28 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1639
Mailing Address - Country:US
Mailing Address - Phone:917-656-9439
Mailing Address - Fax:
Practice Address - Street 1:28 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-1639
Practice Address - Country:US
Practice Address - Phone:917-656-9439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-24
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty