Provider Demographics
NPI:1992114300
Name:YUDIN, ALTER Y (LISW)
Entity type:Individual
Prefix:
First Name:ALTER
Middle Name:Y
Last Name:YUDIN
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3268 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-2220
Mailing Address - Country:US
Mailing Address - Phone:513-800-3008
Mailing Address - Fax:513-712-0006
Practice Address - Street 1:3268 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2220
Practice Address - Country:US
Practice Address - Phone:513-800-3008
Practice Address - Fax:513-712-0006
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI13036021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical