Provider Demographics
NPI:1841682150
Name:SCUDIERI, TERRENCE WAYNE JR (LCSW)
Entity type:Individual
Prefix:MR
First Name:TERRENCE
Middle Name:WAYNE
Last Name:SCUDIERI
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 N BEACON PL
Mailing Address - Street 2:APT 708
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2037
Mailing Address - Country:US
Mailing Address - Phone:630-400-1185
Mailing Address - Fax:
Practice Address - Street 1:1 N BEACON PL
Practice Address - Street 2:APT 708
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2037
Practice Address - Country:US
Practice Address - Phone:630-400-1185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72-089155104100000X
IL149-0172961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker