Provider Demographics
NPI:1881676336
Name:LUDDY, JEFFREY GEORGE (LCSW)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:GEORGE
Last Name:LUDDY
Suffix:
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 1:24 NANCY MAE AVE
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-1719
Mailing Address - Country:US
Mailing Address - Phone:203-527-9648
Mailing Address - Fax:
Practice Address - Street 1:55 W MAIN ST STE 410
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-5524
Practice Address - Country:US
Practice Address - Phone:203-805-6400
Practice Address - Fax:203-805-6432
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0058861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical