Provider Demographics
NPI:1710009758
Name:HUDOME, JOHN B JR (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:HUDOME
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 EVES DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3193
Mailing Address - Country:US
Mailing Address - Phone:856-797-8777
Mailing Address - Fax:856-797-6764
Practice Address - Street 1:2 EVES DR
Practice Address - Street 2:SUITE 104
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3193
Practice Address - Country:US
Practice Address - Phone:856-797-8777
Practice Address - Fax:856-797-6764
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC013893001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical