Provider Demographics
NPI:1982176814
Name:ADLER, TRUDY (MSW, LMSW)
Entity Type:Individual
Prefix:
First Name:TRUDY
Middle Name:
Last Name:ADLER
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:TRUDY
Other - Middle Name:
Other - Last Name:CAUDRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SWT, LBSW
Mailing Address - Street 1:1155 DERBY RD APT 7
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-5804
Mailing Address - Country:US
Mailing Address - Phone:734-985-0402
Mailing Address - Fax:
Practice Address - Street 1:34505 W 12 MILE RD STE 100
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3287
Practice Address - Country:US
Practice Address - Phone:855-559-7178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010896581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty