Provider Demographics
NPI:1205392065
Name:RUDIS, MICHAEL M (LMSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:M
Last Name:RUDIS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:LYNN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:1631 ELYSIAN FIELDS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70117-8208
Mailing Address - Country:US
Mailing Address - Phone:504-821-2601
Mailing Address - Fax:
Practice Address - Street 1:1631 ELYSIAN FIELDS AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70117-8208
Practice Address - Country:US
Practice Address - Phone:504-607-2489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15199171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator