Provider Demographics
NPI:1396098356
Name:RUDNYTSKY, PETER L (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:L
Last Name:RUDNYTSKY
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 W UNIVERSITY AVE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-3248
Mailing Address - Country:US
Mailing Address - Phone:352-339-2288
Mailing Address - Fax:
Practice Address - Street 1:408 W UNIVERSITY AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-3248
Practice Address - Country:US
Practice Address - Phone:352-339-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL99991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical