Provider Demographics
NPI:1073983110
Name:HUDSON, TAMIKA (LMSW-R)
Entity type:Individual
Prefix:
First Name:TAMIKA
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:LMSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2108
Mailing Address - Country:US
Mailing Address - Phone:315-373-5971
Mailing Address - Fax:315-802-4539
Practice Address - Street 1:753 JAMES ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2108
Practice Address - Country:US
Practice Address - Phone:315-373-5971
Practice Address - Fax:315-802-4539
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0748461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical