Provider Demographics
NPI:1518796481
Name:DUDLEY, HARRISON ROBERT
Entity type:Individual
Prefix:
First Name:HARRISON
Middle Name:ROBERT
Last Name:DUDLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 FLAGLER AVE
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4607
Mailing Address - Country:US
Mailing Address - Phone:305-587-5840
Mailing Address - Fax:
Practice Address - Street 1:513 FLEMING ST STE 14
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-6887
Practice Address - Country:US
Practice Address - Phone:305-453-6334
Practice Address - Fax:305-453-6374
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-364965106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician