Provider Demographics
NPI:1134180037
Name:CHRUDEN, MARYBETH (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARYBETH
Middle Name:
Last Name:CHRUDEN
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 1:767 ACADEMY DR
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075
Mailing Address - Country:US
Mailing Address - Phone:858-481-7346
Mailing Address - Fax:858-793-4406
Practice Address - Street 1:767 ACADEMY DR
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075
Practice Address - Country:US
Practice Address - Phone:858-481-7346
Practice Address - Fax:858-793-4406
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALSW103491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACSW103490Medicaid
CACSW103490Medicaid