Provider Demographics
NPI:1386979045
Name:RUDNICK, SALLY S (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:S
Last Name:RUDNICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:SALLY
Other - Middle Name:S
Other - Last Name:JAMES RUDNICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:90 HAMBLETONIAN RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10918-1741
Mailing Address - Country:US
Mailing Address - Phone:845-610-5067
Mailing Address - Fax:
Practice Address - Street 1:244 5TH AVE
Practice Address - Street 2:STE 9A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7604
Practice Address - Country:US
Practice Address - Phone:718-282-0010
Practice Address - Fax:718-693-4490
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0710721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical