Provider Demographics
NPI:1063884823
Name:CUDJOE, GLADYS L (LCSW, MASTER-CASAC)
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:L
Last Name:CUDJOE
Suffix:
Gender:F
Credentials:LCSW, MASTER-CASAC
Other - Prefix:
Other - First Name:GLADYS
Other - Middle Name:L
Other - Last Name:SALIZAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:36 JOYCE AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-3729
Mailing Address - Country:US
Mailing Address - Phone:718-506-7156
Mailing Address - Fax:
Practice Address - Street 1:36 JOYCE AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-3729
Practice Address - Country:US
Practice Address - Phone:718-506-7156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28147101YA0400X
NY0913751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)