Provider Demographics
NPI:1356415079
Name:TRUDEL, ROBERT MICHAEL
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
Last Name:TRUDEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 STAGECOACH RD
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-3472
Mailing Address - Country:US
Mailing Address - Phone:978-537-4920
Mailing Address - Fax:
Practice Address - Street 1:390 MAIN ST
Practice Address - Street 2:SUITE 547
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-2583
Practice Address - Country:US
Practice Address - Phone:508-754-0398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2277103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7049OtherUNITED BEHAVIORAL HEALTH
MAW10066OtherBLUE CROSS BLUE SHIELD
MA008865OtherHARVARD PILGRIM
MA25700-00OtherCIGNA
MA701795OtherTUFTS HEALTH PLAN
MA7049OtherUNITED BEHAVIORAL HEALTH