Provider Demographics
NPI:1760669006
Name:PUDDU, RONALD N (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:N
Last Name:PUDDU
Suffix:
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 1:173 WEST 78TH ST
Mailing Address - Street 2:#1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6707
Mailing Address - Country:US
Mailing Address - Phone:212-496-1204
Mailing Address - Fax:
Practice Address - Street 1:173 WEST 78TH ST
Practice Address - Street 2:#1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6707
Practice Address - Country:US
Practice Address - Phone:212-496-1204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR026906104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN26641Medicare PIN