Provider Demographics
NPI:1407136914
Name:TUDMAN, CARI LYNN (MST)
Entity Type:Individual
Prefix:
First Name:CARI
Middle Name:LYNN
Last Name:TUDMAN
Suffix:
Gender:F
Credentials:MST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6176 RIDGECREST DR
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-1826
Mailing Address - Country:US
Mailing Address - Phone:315-458-9951
Mailing Address - Fax:
Practice Address - Street 1:6176 RIDGECREST DR
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-1826
Practice Address - Country:US
Practice Address - Phone:315-458-9951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089721011101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor