Provider Demographics
NPI:1073336350
Name:RUDAWSKY, ALYSSA (LCSW)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:RUDAWSKY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3230
Mailing Address - Country:US
Mailing Address - Phone:610-357-2781
Mailing Address - Fax:
Practice Address - Street 1:2710 5TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3230
Practice Address - Country:US
Practice Address - Phone:610-357-2781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099306441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical