Provider Demographics
NPI:1801805643
Name:TRUDEL, JACQUES LUCIEN (MA,LADC I)
Entity type:Individual
Prefix:MR
First Name:JACQUES
Middle Name:LUCIEN
Last Name:TRUDEL
Suffix:
Gender:M
Credentials:MA,LADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-3957
Mailing Address - Country:US
Mailing Address - Phone:508-438-5583
Mailing Address - Fax:508-421-4362
Practice Address - Street 1:12 QUEEN STREET
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610
Practice Address - Country:US
Practice Address - Phone:508-438-5583
Practice Address - Fax:508-421-4362
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1645101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)