Provider Demographics
NPI:1508818436
Name:DUDLEY, ROY ALAN (MSW, LICSW)
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:ALAN
Last Name:DUDLEY
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-1851
Mailing Address - Country:US
Mailing Address - Phone:413-730-5337
Mailing Address - Fax:
Practice Address - Street 1:4 MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-3150
Practice Address - Country:US
Practice Address - Phone:413-730-5337
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10194071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP06084OtherBCBS PROVIDER #