Provider Demographics
NPI:1811570351
Name:NOEL, JUDE PEGGY (LPN, CASAC-T)
Entity Type:Individual
Prefix:
First Name:JUDE
Middle Name:PEGGY
Last Name:NOEL
Suffix:
Gender:M
Credentials:LPN, CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 BOSTON RD APT 5N
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-4969
Mailing Address - Country:US
Mailing Address - Phone:917-617-3842
Mailing Address - Fax:
Practice Address - Street 1:1490 BOSTON RD APT 5N
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-4969
Practice Address - Country:US
Practice Address - Phone:917-617-3842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)