Provider Demographics
NPI:1477991412
Name:WUDARSKI, STEPHANIE BECKER (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:BECKER
Last Name:WUDARSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ALYSSA
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5700 BUNKERHILL ST APT 1703
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-1167
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3020 BAILEY AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-2814
Practice Address - Country:US
Practice Address - Phone:716-831-1800
Practice Address - Fax:716-831-1818
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2022-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0199671041C0700X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical