Provider Demographics
NPI:1013089135
Name:JUDEM-CAUTIN, ROBERT I (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:JUDEM-CAUTIN
Suffix:I
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 1:70 E 10TH ST APT 20G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-5120
Mailing Address - Country:US
Mailing Address - Phone:917-880-2142
Mailing Address - Fax:
Practice Address - Street 1:514 49TH ST
Practice Address - Street 2:LUTHERAN HOSPITAL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2010
Practice Address - Country:US
Practice Address - Phone:718-431-2641
Practice Address - Fax:718-437-5239
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR34919104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY0033S128Medicare ID - Type Unspecified