Active NPI
Phaedra Ruddock-Dunn, LSW
- Social Worker
- Short Hills, NJ
National Provider Identifier
1194248096
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 44SL06030800
- Practice address
- 748 Morris Tpke Ste 210
Short Hills, NJ 07078-2617 - Phone
- (646) 458-1049
- NPI assigned
- Jul 23, 2017
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 44SL06030800 | NJ | Primary |
Addresses
Primary practice location
748 Morris Tpke Ste 210
Short Hills, NJ 07078-2617
Mailing address
17 Lackawanna PL Apt 219
Bloomfield, NJ 07003-2956
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 44SL06030800 | NJ | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1500768000000",
"number": "1194248096",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 LACKAWANNA PL APT 219",
"city": "BLOOMFIELD",
"state": "NJ",
"postal_code": "070032956"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "748 MORRIS TPKE STE 210",
"city": "SHORT HILLS",
"state": "NJ",
"postal_code": "070782617",
"telephone_number": "646-458-1049"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDDOCK-DUNN",
"first_name": "PHAEDRA",
"name_prefix": "Mrs.",
"credential": "LSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-07-23",
"last_updated": "2017-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NJ",
"license": "44SL06030800",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Short Hills, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.