Provider Demographics
NPI:1740559343
Name:RUDD, DANIEL HEWSON (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:HEWSON
Last Name:RUDD
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1568 CREEKSIDE DRIVE
Mailing Address - Street 2:STE 206
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630
Mailing Address - Country:US
Mailing Address - Phone:916-984-9148
Mailing Address - Fax:
Practice Address - Street 1:1568 CREEKSIDE DRIVE
Practice Address - Street 2:STE 206
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630
Practice Address - Country:US
Practice Address - Phone:916-984-9148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS62361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical