Provider Demographics
NPI:1821076894
Name:DUDGEON, KAREN BRADY (LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:BRADY
Last Name:DUDGEON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17-29 MAIN ST 420
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045
Mailing Address - Country:US
Mailing Address - Phone:607-527-0575
Mailing Address - Fax:888-972-1815
Practice Address - Street 1:17-29 MAIN ST 420
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045
Practice Address - Country:US
Practice Address - Phone:607-527-0575
Practice Address - Fax:888-927-1815
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074330-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical