Provider Demographics
NPI:1194967679
Name:TRUDEAU, RUTH (LMFT, LADC)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:TRUDEAU
Suffix:
Gender:F
Credentials:LMFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06039-0004
Mailing Address - Country:US
Mailing Address - Phone:860-435-3505
Mailing Address - Fax:860-435-3505
Practice Address - Street 1:15 PORTER ST
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:CT
Practice Address - Zip Code:06039-1214
Practice Address - Country:US
Practice Address - Phone:860-435-3505
Practice Address - Fax:860-435-3505
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-31
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000318101YA0400X
CT000601106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)