Individual
DR. JASON MARC RUDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
48 SOUTH BREEZE DRIVE, WAINSCOTT, NY 11975
(917) 750-8400
Mailing address
PO BOX 1006, WAINSCOTT, NY 11975-1006
(917) 750-8400
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
017306
NY
103TC0700X
Clinical Psychologist
35868
CA
Other
Enumeration date
09/09/2025
Last updated
09/09/2025
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