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NPI Code Detail

MEDICARE: JANE RUDISILL LCSW

MEDICARE: JANE RUDISILL LCSW
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
11041C0700XClinical Social WorkerSW3697FL

General Provider Information

NPI Number : 1376643056
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANE RUDISILL LCSW
Provider Business Mailing Address
First Line : 2808 NE 22ND ST
Second Line :
City : FT LAUDERDALE
State : FL
Zip : 33305-2804
Country : US
Telephone Number : 954-564-9460
Fax Number :
Provider Business Practice Location Address
First Line : 2808 NE 22ND ST
Second Line :
City : FT LAUDERDALE
State : FL
Zip : 33305-2804
Country : US
Telephone Number : 954-564-9460
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2006
Last Update Date : 07/08/2007

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Directions to “ JANE RUDISILL LCSW” Practice Location

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