Provider Demographics
NPI:1518675602
Name:XIA, YUDI (LMSW, ASW, LSW)
Entity Type:Individual
Prefix:
First Name:YUDI
Middle Name:
Last Name:XIA
Suffix:
Gender:F
Credentials:LMSW, ASW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 RIVER TER APT 19B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10282-1215
Mailing Address - Country:US
Mailing Address - Phone:312-723-9373
Mailing Address - Fax:
Practice Address - Street 1:299 BROADWAY STE 1115
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-1901
Practice Address - Country:US
Practice Address - Phone:646-250-8212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1180621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical