Provider Demographics
NPI:1942406244
Name:RUDOY, SALLY HECHINGER (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:HECHINGER
Last Name:RUDOY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 BROADWAY
Mailing Address - Street 2:SUITE #1008
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4709
Mailing Address - Country:US
Mailing Address - Phone:646-237-4172
Mailing Address - Fax:973-746-9726
Practice Address - Street 1:817 BROADWAY
Practice Address - Street 2:SUITE 1008
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4709
Practice Address - Country:US
Practice Address - Phone:646-237-4172
Practice Address - Fax:973-746-9726
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-23
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078410-11041C0700X
NJ44SCO49250001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ034041Medicare ID - Type Unspecified