Provider Demographics
NPI:1235601451
Name:RUDOLPH, JOEL DAVID SR (LAMFT)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:DAVID
Last Name:RUDOLPH
Suffix:SR
Gender:M
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:876 ALPS RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3905
Mailing Address - Country:US
Mailing Address - Phone:973-445-5647
Mailing Address - Fax:973-742-5100
Practice Address - Street 1:33-11 BROADWAY STE 203
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-4638
Practice Address - Country:US
Practice Address - Phone:973-769-3699
Practice Address - Fax:973-389-9110
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FA00000400106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist