Provider Demographics
NPI:1629304571
Name:POWELL, TRUDY-ANN ELIZABETH (MSW, MST, MHP)
Entity Type:Individual
Prefix:MRS
First Name:TRUDY-ANN
Middle Name:ELIZABETH
Last Name:POWELL
Suffix:
Gender:F
Credentials:MSW, MST, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9135 RAMBLEWOOD DR
Mailing Address - Street 2:133
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7018
Mailing Address - Country:US
Mailing Address - Phone:954-682-1104
Mailing Address - Fax:
Practice Address - Street 1:3500 N STATE ROAD 7
Practice Address - Street 2:212
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5600
Practice Address - Country:US
Practice Address - Phone:954-578-8399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW 55681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical