Provider Demographics
NPI:1033964218
Name:RUDRA, BIDISHA
Entity Type:Individual
Prefix:DR
First Name:BIDISHA
Middle Name:
Last Name:RUDRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5604 OAK FALLS CIR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-7528
Mailing Address - Country:US
Mailing Address - Phone:972-975-8349
Mailing Address - Fax:
Practice Address - Street 1:5604 OAK FALLS CIR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-7528
Practice Address - Country:US
Practice Address - Phone:972-975-8349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker