Provider Demographics
NPI:1164823589
Name:RUDOFF, REBECCA DOROTHY (BA)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:DOROTHY
Last Name:RUDOFF
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:DOROTHY
Other - Last Name:RUDOFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA
Mailing Address - Street 1:2814 S US HIGHWAY 1 STE D4
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-8110
Mailing Address - Country:US
Mailing Address - Phone:772-979-1135
Mailing Address - Fax:
Practice Address - Street 1:2814 S US HIGHWAY 1 STE D4
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-8110
Practice Address - Country:US
Practice Address - Phone:772-979-1135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health