Provider Demographics
NPI:1497765101
Name:DUDA, JOHN THOMAS (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:THOMAS
Last Name:DUDA
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 WINWAY CIR
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-4213
Mailing Address - Country:US
Mailing Address - Phone:650-619-8887
Mailing Address - Fax:
Practice Address - Street 1:1838 EL CAMINO REAL
Practice Address - Street 2:203
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3126
Practice Address - Country:US
Practice Address - Phone:650-697-2029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT15232101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health