Provider Demographics
NPI:1669804126
Name:HUDSON, RENEE JOY (MA)
Entity type:Individual
Prefix:MS
First Name:RENEE
Middle Name:JOY
Last Name:HUDSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 S ORANGE BLOSSOM TRL
Mailing Address - Street 2:SUITE 231
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-3118
Mailing Address - Country:US
Mailing Address - Phone:407-649-6718
Mailing Address - Fax:407-649-6719
Practice Address - Street 1:750 S ORANGE BLOSSOM TRL
Practice Address - Street 2:SUITE 231
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-3118
Practice Address - Country:US
Practice Address - Phone:407-649-6718
Practice Address - Fax:407-649-6719
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL462897013OtherMENTAL HEALTH TARGETED CASE MANAGER SUPERVISOR