Provider Demographics
NPI:1598338055
Name:PUDER, KATHERINE LYNN (LSW)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:LYNN
Last Name:PUDER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 N RIDGEWOOD RD APT 315
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1546
Mailing Address - Country:US
Mailing Address - Phone:917-704-1060
Mailing Address - Fax:
Practice Address - Street 1:10 N RIDGEWOOD RD APT 315
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-1546
Practice Address - Country:US
Practice Address - Phone:917-704-1060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL065503001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical