Provider Demographics
NPI:1134336399
Name:HUDAK, STACY DYAN (LMFT)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:DYAN
Last Name:HUDAK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 W 24TH ST
Mailing Address - Street 2:SUITE 612
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-3206
Mailing Address - Country:US
Mailing Address - Phone:917-745-6993
Mailing Address - Fax:
Practice Address - Street 1:437 PROSPECT AVE APT 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-5843
Practice Address - Country:US
Practice Address - Phone:917-745-6993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000908106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist