Provider Demographics
NPI:1689972937
Name:TUD, NICOLE-ANNE
Entity Type:Individual
Prefix:
First Name:NICOLE-ANNE
Middle Name:
Last Name:TUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 PHILADELPHIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-4210
Mailing Address - Country:US
Mailing Address - Phone:240-292-1719
Mailing Address - Fax:
Practice Address - Street 1:314 PHILADELPHIA AVE
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-4210
Practice Address - Country:US
Practice Address - Phone:240-292-1719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst