Provider Demographics
NPI:1457656134
Name:TRUDEAU, PALIKA (MA PSYCHOLOGY)
Entity Type:Individual
Prefix:
First Name:PALIKA
Middle Name:
Last Name:TRUDEAU
Suffix:
Gender:F
Credentials:MA PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32616-0044
Mailing Address - Country:US
Mailing Address - Phone:352-283-3102
Mailing Address - Fax:
Practice Address - Street 1:14616 NW 140TH ST
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-6261
Practice Address - Country:US
Practice Address - Phone:352-283-3102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT 887106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist