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General NPI Number Information
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NPI Number | 1326277534
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE PSYCHOLOGICAL AND ASSESSMENT SERVICES
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Dates
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Enumeration Date | 07/09/2009
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Last Update Date | 07/09/2009
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Provider Practice Location Address
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Address Line | 283 CRANES ROOST BLVD 111
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-3418
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Country | US
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Telephone | 352-455-7958
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Fax |
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Provider Business Mailing Address
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Address Line | 283 CRANES ROOST BLVD 111
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-3418
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Country | US
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Telephone | 352-455-7958
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MAXINE ANN-MARIE RUDDOCK
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Credential | PH.D.
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Telephone | 352-455-7958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY7658
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License Number State | FL
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