Provider Demographics
NPI:1669771747
Name:CUDA, J. CHRISTOPHER (LISW)
Entity type:Individual
Prefix:
First Name:J. CHRISTOPHER
Middle Name:
Last Name:CUDA
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:J
Other - Last Name:CUDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW
Mailing Address - Street 1:1865 N RIDGE RD E STE D
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44055-3359
Mailing Address - Country:US
Mailing Address - Phone:440-341-0270
Mailing Address - Fax:440-277-0459
Practice Address - Street 1:1865 N RIDGE RD E STE D
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055
Practice Address - Country:US
Practice Address - Phone:440-341-0270
Practice Address - Fax:440-277-0459
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI08002931041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0210684Medicaid