Provider Demographics
NPI:1073948501
Name:RUDBERG & RUDBERG, LLC
Entity Type:Organization
Organization Name:RUDBERG & RUDBERG, LLC
Other - Org Name:RONALD L. RUDBERG COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:412-427-7495
Mailing Address - Street 1:9 COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012-1309
Mailing Address - Country:US
Mailing Address - Phone:412-427-7495
Mailing Address - Fax:724-243-3161
Practice Address - Street 1:601 BROAD AVE
Practice Address - Street 2:
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012-1564
Practice Address - Country:US
Practice Address - Phone:412-427-7495
Practice Address - Fax:724-243-3161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000359101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102018212 0001Medicaid