Provider Demographics
NPI:1235111675
Name:RUDIC, ROBIN ADDELL (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:ADDELL
Last Name:RUDIC
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7990 E SNYDER RD
Mailing Address - Street 2:2104
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-6530
Mailing Address - Country:US
Mailing Address - Phone:520-760-0482
Mailing Address - Fax:520-760-0482
Practice Address - Street 1:1010 E 10TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-5813
Practice Address - Country:US
Practice Address - Phone:520-225-6410
Practice Address - Fax:520-225-6410
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0131801041C0700X
AZ3783803103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00664199OtherHIGHMARK
AZ132932Medicaid