Provider Demographics
NPI:1033735436
Name:RUDOLPH, AMIE LOIS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AMIE
Middle Name:LOIS
Last Name:RUDOLPH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UCSF BENIOFF CHILDREN'S HOSPITAL
Mailing Address - Street 2:1975 4TH STREET
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94930
Mailing Address - Country:US
Mailing Address - Phone:415-476-4272
Mailing Address - Fax:415-476-5363
Practice Address - Street 1:UCSF BENIOFF CHILDREN'S HOSPITAL
Practice Address - Street 2:1975 4TH STREET
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94930
Practice Address - Country:US
Practice Address - Phone:415-476-4272
Practice Address - Fax:415-476-5363
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW222501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical