Individual
MAXINE A RUDDOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
2511 DORA AVE, TAVARES, FL 32778-4977
(352) 508-5399
(917) 677-7121
Mailing address
2511 DORA AVE, TAVARES, FL 32778-4977
(352) 508-5399
(917) 677-7121
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
PY7658
FL
101YA0400X
Addiction (Substance Use Disorder) Counselor
PY7658
FL
101YM0800X
Mental Health Counselor
PY7658
FL
101YP2500X
Professional Counselor
PY7658
FL
103T00000X
Psychologist
PY7658
FL
103TA0400X
Addiction (Substance Use Disorder) Psychologist
PY7658
FL
103TA0700X
Adult Development & Aging Psychologist
PY7658
FL
103TB0200X
Cognitive & Behavioral Psychologist
PY7658
FL
103TC0700X
Clinical Psychologist
Primary
PY7658
FL
103TC1900X
Counseling Psychologist
PY7658
FL
103TC2200X
Clinical Child & Adolescent Psychologist
PY7658
FL
103TF0000X
Family Psychologist
PY7658
FL
103TM1800X
Intellectual & Developmental Disabilities Psychologist
PY7658
FL
103TP2701X
Group Psychotherapy Psychologist
PY7658
FL
1041C0700X
Clinical Social Worker
PY7658
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004105100
—
FL
05
—
008648900
—
FL
Enumeration date
02/08/2008
Last updated
05/02/2015
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