Provider Demographics
NPI:1982749115
Name:DUDLER, LORI
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:
Last Name:DUDLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6551 BALBOA BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406
Mailing Address - Country:US
Mailing Address - Phone:310-428-4098
Mailing Address - Fax:310-428-4098
Practice Address - Street 1:6651 BALBOA BLVD
Practice Address - Street 2:VAN NUYS
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-5529
Practice Address - Country:US
Practice Address - Phone:310-428-4098
Practice Address - Fax:310-428-4098
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 256811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical