Maryanne Kudlek

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

16130 Issued in NC

Practice address

5029 Henshaw Rd
Waxhaw, NC 28173-4546

Phone

(631) 790-5122

NPI assigned

Jan 16, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY, NC2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Clinical, NC, NY

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1705363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705363200000",
    "number": "1336900596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5029 HENSHAW RD",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281734546",
            "telephone_number": "631-790-5122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5029 HENSHAW RD",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281734546",
            "telephone_number": "631-790-5122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUDLEK",
        "first_name": "MARYANNE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-01-16",
        "last_updated": "2024-01-16",
        "certification_date": "2024-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "16130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Saveena Kondaveeti
• Caleigh Koppelmann, MS
• Sarah Madina Kornstein
• Judith Kramer
• Jacob Hunter Krauss
• Janice Kunnakkattu, NP-C
• Kupperi and Kommineni DDS PLLC
• Lori S Kury, M.S, CCC-SLP
• Leanne Labrecque
• Alexandra Judith Lagunas, LCSW

• Clinical Social Worker in Waxhaw, NC
• Providers in Waxhaw, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.