Provider Demographics
NPI:1720152499
Name:LUDLOW, THOMAS W (MSSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:W
Last Name:LUDLOW
Suffix:
Gender:M
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 NORTHSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-9258
Mailing Address - Country:US
Mailing Address - Phone:732-294-9501
Mailing Address - Fax:
Practice Address - Street 1:17 NORTHSHIRE CT
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-9258
Practice Address - Country:US
Practice Address - Phone:732-294-9501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00036300101YA0400X
NJ44SC014557001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ683149Medicare ID - Type Unspecified