Provider Demographics
NPI:1871100099
Name:HUDSON, JOSEPH ROBERT (LMSW, CIHC, CASAC-T)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ROBERT
Last Name:HUDSON
Suffix:
Gender:M
Credentials:LMSW, CIHC, CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 E 25TH ST APT 2B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2329
Mailing Address - Country:US
Mailing Address - Phone:347-276-2636
Mailing Address - Fax:
Practice Address - Street 1:161 E 25TH ST APT 2B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2329
Practice Address - Country:US
Practice Address - Phone:347-276-2636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104543104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty