Ruddock, Maxine A

Ruddock, Maxine A is an sole proprietor health care provider with primary practice located at 2511 Dora Ave , Tavares FL 32778-4977. She recently has 13 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Group Psychotherapy, Behavioral Health & Social Service Providers / Psychologist, Behavioral Health & Social Service Providers / Adult Development & Aging, Behavioral Health & Social Service Providers / Clinical Child & Adolescent, Behavioral Health & Social Service Providers / Cognitive & Behavioral, Behavioral Health & Social Service Providers / Counseling, Behavioral Health & Social Service Providers / Mental Retardation & Developmental Disabilities, Behavioral Health & Social Service Providers / Counselor, Behavioral Health & Social Service Providers / Family. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Ruddock, Maxine A can be contacted via phone (352) 508-5399.

Contact Information

Primary practice address
2511 Dora Ave Tavares FL 32778-4977
Phone: (352) 508-5399
Fax: (917) 677-7121
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X PY7658 Florida
Behavioral Health & Social Service Providers / Mental Health 101YM0800X PY7658 Florida
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X PY7658 Florida
Behavioral Health & Social Service Providers / Professional 101YP2500X PY7658 Florida
Behavioral Health & Social Service Providers / Clinical 1041C0700X PY7658 Florida
Behavioral Health & Social Service Providers / Group Psychotherapy 103TP2701X PY7658 Florida
Behavioral Health & Social Service Providers / Psychologist 103T00000X PY7658 Florida
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 103TA0400X PY7658 Florida
Behavioral Health & Social Service Providers / Adult Development & Aging 103TA0700X PY7658 Florida
Behavioral Health & Social Service Providers / Clinical Child & Adolescent 103TC2200X PY7658 Florida
Behavioral Health & Social Service Providers / Cognitive & Behavioral 103TB0200X PY7658 Florida
Behavioral Health & Social Service Providers / Counseling 103TC1900X PY7658 Florida
Behavioral Health & Social Service Providers / Mental Retardation & Developmental Disabilities 103TM1800X PY7658 Florida
Behavioral Health & Social Service Providers / Counselor 101Y00000X PY7658 Florida
Behavioral Health & Social Service Providers / Family 103TF0000X PY7658 Florida

Profile Details

NPI number 1205014461
LBN Legal business name Ruddock, Maxine A
Credentials PH.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 8th, 2008
Last updated May 2nd, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205014461 NPPES
Florida MEDICAID 008648900
Florida MEDICAID 004105100

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