Provider Demographics
NPI:1700595733
Name:SUDIA, MELANIE (LCSW)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:SUDIA
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 1:4209 DAIRY CT
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-9122
Mailing Address - Country:US
Mailing Address - Phone:732-689-2811
Mailing Address - Fax:
Practice Address - Street 1:181 SOUTH ST # B1
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2164
Practice Address - Country:US
Practice Address - Phone:732-475-0043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC059547001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical