Provider Demographics
NPI:1598473142
Name:RUDEWICZ, JOANNA L (LSSW)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:L
Last Name:RUDEWICZ
Suffix:
Gender:F
Credentials:LSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2613
Mailing Address - Country:US
Mailing Address - Phone:203-645-3498
Mailing Address - Fax:
Practice Address - Street 1:1 HOLLY RD
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2613
Practice Address - Country:US
Practice Address - Phone:203-645-3498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10887101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health