Individual
LARRY P MUDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1507 SPRING STREET, JEFFERSONVLLE, IN 47130-2939
(407) 347-4536
(812) 235-2434
Mailing address
510 SPRING ST, JEFFERSONVLLE, IN 47130-3554
(812) 282-1888
(812) 218-9318
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
0566
KY
1041C0700X
Clinical Social Worker
Primary
34003409A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2748455000
PASSPORT ADVANTAGE
KY
01
—
800012255
MEDICARE RAILROAD
IN
05
—
8200068800
—
KY
Enumeration date
07/07/2005
Last updated
12/17/2024
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