Provider Demographics
NPI:1992039374
Name:PASS, TRUDIE CAROL
Entity Type:Individual
Prefix:MS
First Name:TRUDIE
Middle Name:CAROL
Last Name:PASS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TRUDIE
Other - Middle Name:CAROL
Other - Last Name:WEISMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:225 LINCOLN PLACE,
Mailing Address - Street 2:APT #1F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3726
Mailing Address - Country:US
Mailing Address - Phone:718-399-7717
Mailing Address - Fax:718-300-7717
Practice Address - Street 1:225 LINCOLN PLACE,
Practice Address - Street 2:APT #1F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-3726
Practice Address - Country:US
Practice Address - Phone:718-399-7717
Practice Address - Fax:718-300-7717
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO19749-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical