Active NPI
Carol Tudor, LPC
- Professional Counselor
- Roseland, NJ
National Provider Identifier
1053011148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 37PC00504100
- Practice address
- 425 Eagle Rock Ave Ste 103
Roseland, NJ 07068-1717 - Phone
- (973) 226-1505
- NPI assigned
- Mar 7, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 37PC00504100 | NM | Primary |
Addresses
Primary practice location
425 Eagle Rock Ave Ste 103
Roseland, NJ 07068-1717
Mailing address
17 Luth Ter
West Orange, NJ 07052-6607
Phone (973) 476-8167
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 12, 2024 through Nov 12, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37PC00504100 | NM | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1678147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1053011148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 LUTH TER",
"city": "WEST ORANGE",
"state": "NJ",
"postal_code": "070526607",
"telephone_number": "973-476-8167"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "425 EAGLE ROCK AVE STE 103",
"city": "ROSELAND",
"state": "NJ",
"postal_code": "070681717",
"telephone_number": "973-226-1505"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TUDOR",
"first_name": "CAROL",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-03-07",
"last_updated": "2023-03-07",
"certification_date": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NM",
"license": "37PC00504100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roseland, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.