Provider Demographics
NPI:1962457259
Name:TRUDEAU, JUDY (LMSW)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:TRUDEAU
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 COMMISSIONER DR
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:GA
Mailing Address - Zip Code:31305-9487
Mailing Address - Country:US
Mailing Address - Phone:912-437-9300
Mailing Address - Fax:912-437-9481
Practice Address - Street 1:1000 COMMISSIONER DR
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:GA
Practice Address - Zip Code:31305-9487
Practice Address - Country:US
Practice Address - Phone:912-437-9300
Practice Address - Fax:912-437-9481
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW003553104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAMSW003553OtherSTATE LICENSE