Provider Demographics
NPI:1376648162
Name:TRUDEAU, PAUL FF (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:FF
Last Name:TRUDEAU
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 PEACHTREE ST.
Mailing Address - Street 2:SUITE 505
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-7017
Mailing Address - Country:US
Mailing Address - Phone:404-872-8065
Mailing Address - Fax:404-872-0925
Practice Address - Street 1:1708 PEACHTREE ST.
Practice Address - Street 2:SUITE 505
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-7017
Practice Address - Country:US
Practice Address - Phone:404-872-8065
Practice Address - Fax:404-872-0925
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1742103T00000X
NY5171103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical