Provider Demographics
NPI:1679188452
Name:CID, YUDY A (MSW)
Entity Type:Individual
Prefix:
First Name:YUDY
Middle Name:A
Last Name:CID
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 UNDERCLIFF AVE # 2
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-7251
Mailing Address - Country:US
Mailing Address - Phone:646-234-3160
Mailing Address - Fax:
Practice Address - Street 1:63A 8TH ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5056
Practice Address - Country:US
Practice Address - Phone:201-541-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ273166606OtherPRIVATE
NJ273166606Medicaid