Doctor Name: | MAXINE A RUDDOCK |
NPI Number: | 1205014461 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | PY7658 |
Business Practice Address: | 2511 Dora Ave Tavares, FL - 327784977 |
Business Phone Number: | 3525085399 |
Business Fax Number: | 9176777121 |
Mailing Address: | 2511 Dora Ave, TAVARES |
State: | FL |
Postal Code: | 327784977 |
Phone Number: | 3525085399 |
Fax Number: | 9176777121 |
NPI Enumeration Date: | 02/08/2008 |
NPI Last Update Date: | 05/02/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | PY7658 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |