MEDICARE: MR. RENE EVARISTE RUDEL MSW, 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
1	1041C0700X	Clinical Social Worker	006587	CT
2	1041S0200X	School Social Worker	006587	CT

General Provider Information

NPI Number	:	1336329275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RENE EVARISTE RUDEL MSW, LCSW

Provider Business Mailing Address
First Line	:	2911 DIXWELL AVE
Second Line	:
City	:	HAMDEN
State	:	CT
Zip	:	06518-3195
Country	:	US
Telephone Number	:	203-288-0156
Fax Number	:	203-288-0156

Provider Business Practice Location Address
First Line	:	2911 DIXWELL AVE
Second Line	:
City	:	HAMDEN
State	:	CT
Zip	:	06518-3195
Country	:	US
Telephone Number	:	203-288-0156
Fax Number	:	203-288-0156

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

Provider Enumeration Date	:	11/08/2007
Last Update Date	:	04/13/2010

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