Individual
IRIS MARIE RUDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
119 W 124TH ST, NEW YORK, NY 10027-4920
(212) 932-2810
Mailing address
119 W 124TH ST, NEW YORK, NY 10027-4920
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
104100000X
Social Worker
105314
NY
Other
Enumeration date
12/19/2018
Last updated
06/21/2021
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