Provider Demographics
NPI:1285751198
Name:RUDDY, PATRICIA A (MFT# 41928)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:RUDDY
Suffix:
Gender:F
Credentials:MFT# 41928
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 HAMPSHIRE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2379
Mailing Address - Country:US
Mailing Address - Phone:805-405-2850
Mailing Address - Fax:805-374-1774
Practice Address - Street 1:699 HAMPSHIRE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2379
Practice Address - Country:US
Practice Address - Phone:805-405-2850
Practice Address - Fax:805-374-1774
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT# 41928101YA0400X, 101YM0800X
CAMFT#41928106H00000X
CAMFC41928101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional