Provider Demographics
NPI:1780097592
Name:HUDSON, JONATHAN MARCE (LCSW)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MARCE
Last Name:HUDSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 E OLIVE AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-4051
Mailing Address - Country:US
Mailing Address - Phone:209-675-0144
Mailing Address - Fax:209-850-9411
Practice Address - Street 1:384 E OLIVE AVE STE 4
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-4051
Practice Address - Country:US
Practice Address - Phone:209-620-8464
Practice Address - Fax:209-850-9411
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW743201041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical