Organization
MAXINE A RUDDOCK PHD P A
Active
Organization
MAXINE A RUDDOCK PHD P A
Active
Other names
Comprehensive Psychological & Assessment Services
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAXINE A RUDDOCK PH.D. (DIRECTOR)
(352) 508-5399
Entity
Organization
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
251B00000X
Case Management Agency
PY7658
FL
251S00000X
Community/Behavioral Health Agency
Primary
PY7658
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004100300
—
FL
05
—
004100303
—
FL
05
—
008487400
—
FL
Enumeration date
02/22/2008
Last updated
04/27/2015
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