| Doctor Name: | ALYSON ANNE RUDOLPH |
| NPI Number: | 1033372008 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMHC |
| License Number: | MH 9286 |
| Business Practice Address: | 2020 Talley Rd Leesburg, FL - 347483426 |
| Business Phone Number: | 3523157800 |
| Business Fax Number: | 3523606582 |
| Mailing Address: | 1311 Rain Forest Ln, MINNEOLA |
| State: | FL |
| Postal Code: | 347155623 |
| Phone Number: | 3523157500 |
| Fax Number: | 3523606582 |
| NPI Enumeration Date: | 07/09/2008 |
| NPI Last Update Date: | 07/09/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | MH 9286 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |