MEDICARE: ROBERT MICHAEL TRUDEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TH0100X	Health Service Psychologist	2277	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7049	OTHER	MA	UNITED BEHAVIORAL HEALTH
2	W10066	OTHER	MA	BLUE CROSS BLUE SHIELD
3	008865	OTHER	MA	HARVARD PILGRIM
4	25700-00	OTHER	MA	CIGNA
5	701795	OTHER	MA	TUFTS HEALTH PLAN

General Provider Information

NPI Number	:	1356415079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT MICHAEL TRUDEL

Provider Business Mailing Address
First Line	:	14 STAGECOACH RD
Second Line	:
City	:	LEOMINSTER
State	:	MA
Zip	:	01453-3472
Country	:	US
Telephone Number	:	978-537-4920
Fax Number	:

Provider Business Practice Location Address
First Line	:	390 MAIN ST
Second Line	:	SUITE 547
City	:	WORCESTER
State	:	MA
Zip	:	01608-2583
Country	:	US
Telephone Number	:	508-754-0398
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	03/15/2026

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