Provider Demographics
NPI:1740353499
Name:BUDNIK, DEBRA K (LCSWR)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:K
Last Name:BUDNIK
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 BONTICOUVIEW DRIVE.
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1004
Mailing Address - Country:US
Mailing Address - Phone:845-255-4218
Mailing Address - Fax:845-255-6526
Practice Address - Street 1:13 BONTECOU VIEW DR
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1004
Practice Address - Country:US
Practice Address - Phone:845-255-4218
Practice Address - Fax:845-255-6526
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR043006101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02069905Medicaid
NY7482341002OtherGHI
NY02069905Medicaid