Provider Demographics
NPI:1568568715
Name:DRUDY, PATRICK (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:DRUDY
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 1:509 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-2818
Mailing Address - Country:US
Mailing Address - Phone:215-290-6691
Mailing Address - Fax:
Practice Address - Street 1:FOUNDATIONS BEHAVIORAL HEALTH
Practice Address - Street 2:833 E. BUTLER AVE.
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901
Practice Address - Country:US
Practice Address - Phone:215-345-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-002955-L103TC0700X
DEB1-0000480103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA411767129Medicaid
PA413818Medicare ID - Type Unspecified