Provider Demographics
NPI:1285895581
Name:CRUDUP, TARREN EILEEN (MS)
Entity type:Individual
Prefix:
First Name:TARREN
Middle Name:EILEEN
Last Name:CRUDUP
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-2134
Mailing Address - Country:US
Mailing Address - Phone:856-541-1700
Mailing Address - Fax:856-342-9743
Practice Address - Street 1:555 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-2134
Practice Address - Country:US
Practice Address - Phone:856-541-1700
Practice Address - Fax:856-342-9743
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health