Provider Demographics
NPI:1578872800
Name:LUDY, STEPHEN (CADC, LADC)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:LUDY
Suffix:
Gender:M
Credentials:CADC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-2037
Mailing Address - Country:US
Mailing Address - Phone:508-751-6748
Mailing Address - Fax:
Practice Address - Street 1:44 FRONT ST
Practice Address - Street 2:SUITE 490
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1733
Practice Address - Country:US
Practice Address - Phone:508-799-0702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1138 AD101YA0400X
MA34101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)