Provider Demographics
NPI:1205317245
Name:DUDEK, EVA ISABELLA (CAP)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:ISABELLA
Last Name:DUDEK
Suffix:
Gender:F
Credentials:CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16105 88TH RD N
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-2845
Mailing Address - Country:US
Mailing Address - Phone:561-301-9423
Mailing Address - Fax:
Practice Address - Street 1:1547 PROSPERITY FARMS RD
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-2025
Practice Address - Country:US
Practice Address - Phone:561-301-9423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP100191101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)