Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 1041C0700X | Clinical Social Worker | LMHC00359 | RI |
NPI | 1003021726 |
---|---|
Provider Name | Lynne Kudrowitz |
First Address | Warwick, RI 02886 |
Second Address | Warwick, RI 02886-3041 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 02/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30343 | (05) | RI |