Provider Demographics
NPI:1023754900
Name:DUDLEY, NICOLE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 RIVER BANK DR
Mailing Address - Street 2:
Mailing Address - City:ROEBLING
Mailing Address - State:NJ
Mailing Address - Zip Code:08554-1527
Mailing Address - Country:US
Mailing Address - Phone:347-406-0725
Mailing Address - Fax:
Practice Address - Street 1:129 RIVER BANK DR
Practice Address - Street 2:
Practice Address - City:ROEBLING
Practice Address - State:NJ
Practice Address - Zip Code:08554-1527
Practice Address - Country:US
Practice Address - Phone:347-406-0725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-12
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty