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General NPI Number Information
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NPI Number | 1194967679
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Entity Type | Individual
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Provider Name | RUTH TRUDEAU L.M.F.T., L.A.D.C.
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Gender | Female
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Dates
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Enumeration Date | 03/31/2009
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Last Update Date | 12/18/2012
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Provider Practice Location Address
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Address Line | 15 PORTER ST
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City | LAKEVILLE
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State | CT
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Zip | 06039-1214
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Country | US
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Telephone | 860-435-3505
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Fax | 860-435-3505
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Provider Business Mailing Address
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Address Line | PO BOX 4
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City | LAKEVILLE
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State | CT
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Zip | 06039-0004
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Country | US
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Telephone | 860-435-3505
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Fax | 860-435-3505
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 000318
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 000601
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License Number State | CT
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