Individual
BETTY ANN RUDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
21 WATERVILLE RD, AVON, CT 06001-2097
(860) 674-2691
Mailing address
149 MALLARD DR, AVON, CT 06001-4562
(860) 675-5675
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
000311
CT
Other
Enumeration date
08/31/2006
Last updated
07/08/2007
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