Provider Demographics
NPI:1770585481
Name:LUDY, MARY L (LMHC,LMFT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:LUDY
Suffix:
Gender:F
Credentials:LMHC,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 FRUIT ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2126
Mailing Address - Country:US
Mailing Address - Phone:508-797-0537
Mailing Address - Fax:508-797-0611
Practice Address - Street 1:23 FRUIT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2126
Practice Address - Country:US
Practice Address - Phone:508-797-0537
Practice Address - Fax:508-797-0611
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1638101YM0800X
MAMF737106H00000X
MA737106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health