Provider Demographics
NPI:1316226772
Name:RUDY, JAMES MICHAEL (LMSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MICHAEL
Last Name:RUDY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:RUDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:878 S GROVE ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-6345
Mailing Address - Country:US
Mailing Address - Phone:734-480-2611
Mailing Address - Fax:734-448-0204
Practice Address - Street 1:878 S GROVE ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-6345
Practice Address - Country:US
Practice Address - Phone:734-480-2611
Practice Address - Fax:734-448-0204
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010041441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical