Provider Demographics
NPI:1447757463
Name:TRUDEAU, SOPHIE (LCSW)
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:
Last Name:TRUDEAU
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 1:9225 ABBOTT AVE
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE
Mailing Address - State:FL
Mailing Address - Zip Code:33154-3011
Mailing Address - Country:US
Mailing Address - Phone:786-405-5598
Mailing Address - Fax:
Practice Address - Street 1:9225 ABBOTT AVE
Practice Address - Street 2:
Practice Address - City:SURFSIDE
Practice Address - State:FL
Practice Address - Zip Code:33154-3011
Practice Address - Country:US
Practice Address - Phone:786-405-5598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW148421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical