Provider Demographics
NPI:1437816915
Name:DUDANOWICZ, COLLIN
Entity Type:Individual
Prefix:
First Name:COLLIN
Middle Name:
Last Name:DUDANOWICZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:PAXINOS
Mailing Address - State:PA
Mailing Address - Zip Code:17860-7238
Mailing Address - Country:US
Mailing Address - Phone:570-975-9321
Mailing Address - Fax:
Practice Address - Street 1:1012 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PAXINOS
Practice Address - State:PA
Practice Address - Zip Code:17860-7238
Practice Address - Country:US
Practice Address - Phone:570-975-9321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent