Provider Demographics
NPI:1962000224
Name:RHUDY, PAUL WESLEY (LCSW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:WESLEY
Last Name:RHUDY
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 1:2 EAGLESHEAD RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-9659
Mailing Address - Country:US
Mailing Address - Phone:607-592-6607
Mailing Address - Fax:
Practice Address - Street 1:100 WHIG ST
Practice Address - Street 2:
Practice Address - City:TRUMANSBURG
Practice Address - State:NY
Practice Address - Zip Code:14886-9152
Practice Address - Country:US
Practice Address - Phone:607-387-7551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074397-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical