Provider Demographics
NPI:1598786329
Name:HUDAK, CLARK JOSEPH JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:CLARK
Middle Name:JOSEPH
Last Name:HUDAK
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11426 BARROW DOWNS
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-1006
Mailing Address - Country:US
Mailing Address - Phone:410-740-4561
Mailing Address - Fax:
Practice Address - Street 1:201 N CHARLES ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4102
Practice Address - Country:US
Practice Address - Phone:410-576-9191
Practice Address - Fax:410-576-9257
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03047103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical