Provider Demographics
NPI:1356682611
Name:IUDICE, JOHN M (LICSW, MLADC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:IUDICE
Suffix:
Gender:M
Credentials:LICSW, MLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SIMS AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4841
Mailing Address - Country:US
Mailing Address - Phone:603-591-3707
Mailing Address - Fax:603-431-7102
Practice Address - Street 1:85 SIMS AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4841
Practice Address - Country:US
Practice Address - Phone:603-591-3707
Practice Address - Fax:603-431-7102
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0593101YA0400X
NH16371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)