Provider Demographics
NPI:1215432638
Name:RUDNICK, MORGAN TAYLOR
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:TAYLOR
Last Name:RUDNICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18220 MCCORMICK ST
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3611
Mailing Address - Country:US
Mailing Address - Phone:818-631-0508
Mailing Address - Fax:
Practice Address - Street 1:16255 VENTURA BLVD STE 1212
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2320
Practice Address - Country:US
Practice Address - Phone:818-631-0508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist