Individual
DR. STEPHEN GERALD RUDIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ED.D.
Contact information
Practice address
1342 BELMONT ST, SUITE 204, BROCKTON, MA 02301-4436
(508) 427-6911
(508) 588-4639
Mailing address
7301 NW 18TH ST, NO. 204, MARGATE, FL 33063-6857
(954) 970-3205
(954) 957-7505
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY-635-PR
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
290594
MENTAL HEALTH NETWORK MHN
MA
01
—
42279
HARVARD PILGRIM HEALTH CA
MA
01
—
732869
TUFTS HEALTH PLANS
MA
01
—
W01468
BLUE SHIELD OF MASSACHUSE
MA
Enumeration date
10/05/2006
Last updated
07/08/2007
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