Provider Demographics
NPI:1417447079
Name:RUDY, JAMIE LEE (LSW, MSW)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LEE
Last Name:RUDY
Suffix:
Gender:F
Credentials:LSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 W LANDIS AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-8122
Mailing Address - Country:US
Mailing Address - Phone:302-994-2511
Mailing Address - Fax:302-633-5388
Practice Address - Street 1:79 W LANDIS AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-8122
Practice Address - Country:US
Practice Address - Phone:302-994-2511
Practice Address - Fax:302-633-5388
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06186800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker