Provider Demographics
NPI:1154560357
Name:HUDENKO, WILLIAM JOHN (PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOHN
Last Name:HUDENKO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 ROCKY HILL LN
Mailing Address - Street 2:
Mailing Address - City:LYME
Mailing Address - State:NH
Mailing Address - Zip Code:03768-3425
Mailing Address - Country:US
Mailing Address - Phone:607-737-1235
Mailing Address - Fax:
Practice Address - Street 1:23 S MAIN ST STE 2B
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-2075
Practice Address - Country:US
Practice Address - Phone:603-277-9110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017813-1103TC2200X
NH1227103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent