Provider Demographics
NPI:1902566268
Name:RUDGE, BIANCA (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:BIANCA
Middle Name:
Last Name:RUDGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:BIANCA
Other - Middle Name:
Other - Last Name:RUDGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1321 NW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-1603
Mailing Address - Country:US
Mailing Address - Phone:754-300-6745
Mailing Address - Fax:
Practice Address - Street 1:1321 NW 13TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1603
Practice Address - Country:US
Practice Address - Phone:754-300-6745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16520101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health