Healthcare Provider Details

I. General information

NPI: 1235111675
Provider Name (Legal Business Name): ROBIN ADDELL RUDIC LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E 10TH ST
TUCSON AZ
85719-5813
US

IV. Provider business mailing address

7990 E SNYDER RD 2104
TUCSON AZ
85750-6530
US

V. Phone/Fax

Practice location:
  • Phone: 520-225-6410
  • Fax: 520-225-6410
Mailing address:
  • Phone: 520-760-0482
  • Fax: 520-760-0482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW013180
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3783803
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: