Individual
ANN M RUDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L-CSW-R
Contact information
Practice address
1000 MAIN ST, PORT JEFFERSON, NY 11777-2250
(631) 331-4458
Mailing address
1000 MAIN ST, PORT JEFFERSON, NY 11777-2250
(631) 331-4458
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
R037202-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
071480
VALUE OPTIONS
NY
01
—
13690
VYTRA
NY
01
—
5169741
AETNA
NY
01
—
7404242
GHI
NY
01
—
P1626359
OXFORD
NY
Enumeration date
12/29/2006
Last updated
07/08/2007
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