Provider Demographics
NPI:1851336069
Name:RUDZEWICZ, MARIANNE FOUNTAIN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:FOUNTAIN
Last Name:RUDZEWICZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 W WATERS AVE
Mailing Address - Street 2:SUITE 315-B
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2869
Mailing Address - Country:US
Mailing Address - Phone:813-935-1721
Mailing Address - Fax:813-264-5458
Practice Address - Street 1:3105 W WATERS AVE
Practice Address - Street 2:SUITE 315-B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2869
Practice Address - Country:US
Practice Address - Phone:813-935-1721
Practice Address - Fax:813-264-5458
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW30251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical