Provider Demographics
NPI:1053011148
Name:TUDOR, CAROL (LPC)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:TUDOR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 LUTH TER
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-6607
Mailing Address - Country:US
Mailing Address - Phone:973-476-8167
Mailing Address - Fax:
Practice Address - Street 1:425 EAGLE ROCK AVE STE 103
Practice Address - Street 2:
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-1717
Practice Address - Country:US
Practice Address - Phone:973-226-1505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM37PC00504100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional