Provider Demographics
NPI:1477028330
Name:HUDSON, STEPHEN R (LCSW)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:R
Last Name:HUDSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5342 PELHAM WAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46216-2214
Mailing Address - Country:US
Mailing Address - Phone:317-730-3498
Mailing Address - Fax:317-667-1881
Practice Address - Street 1:2040 N SHADELAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-1727
Practice Address - Country:US
Practice Address - Phone:317-355-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34008270A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical