Active NPI
Alyson Anne Rudolph, LMHC
- Clinical Psychologist
- Leesburg, FL
National Provider Identifier
1033372008
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- MH 9286
- Practice address
- 2020 Talley Rd
Leesburg, FL 34748-3426 - Phone
- (352) 315-7800
- Fax
- (352) 360-6582
- NPI assigned
- Jul 9, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | MH 9286 | FL | Primary |
Addresses
Primary practice location
2020 Talley Rd
Leesburg, FL 34748-3426
Mailing address
1311 Rain Forest LN
Minneola, FL 34715-5623
Phone (352) 315-7500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MH 9286 | FL | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lifestream Behavioral Center Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychiatric Hospital
- Leesburg, FL
- NPI 1902802002
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215561600000",
"number": "1033372008",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1311 RAIN FOREST LN",
"city": "MINNEOLA",
"state": "FL",
"postal_code": "347155623",
"telephone_number": "352-315-7500",
"fax_number": "352-360-6582"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2020 TALLEY RD",
"city": "LEESBURG",
"state": "FL",
"postal_code": "347483426",
"telephone_number": "352-315-7800",
"fax_number": "352-360-6582"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDOLPH",
"first_name": "ALYSON",
"middle_name": "ANNE",
"credential": "LMHC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-07-09",
"last_updated": "2008-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "FL",
"license": "MH 9286",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Leesburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.