Provider Demographics
NPI:1760669717
Name:CUDZIOL, JAMES M
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:M
Last Name:CUDZIOL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1640
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96093-1640
Mailing Address - Country:US
Mailing Address - Phone:530-623-1362
Mailing Address - Fax:530-623-1447
Practice Address - Street 1:1979 BERKESEY LN
Practice Address - Street 2:
Practice Address - City:VALLEY SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95252
Practice Address - Country:US
Practice Address - Phone:209-772-3765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77132106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist