Provider Demographics
NPI:1588686018
Name:LUDWIG, TERESA LYNN (LCSW-R, CASAC)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:LUDWIG
Suffix:
Gender:F
Credentials:LCSW-R, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 WESTFALL RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4645
Mailing Address - Country:US
Mailing Address - Phone:585-463-2639
Mailing Address - Fax:585-463-2669
Practice Address - Street 1:465 WESTFALL RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4645
Practice Address - Country:US
Practice Address - Phone:585-463-2639
Practice Address - Fax:585-463-2669
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0723211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01420800Medicaid
NYP99189Medicare UPIN
NY01420800Medicaid