Provider Demographics
NPI:1366861262
Name:RUDOLPH, LINDSAY (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
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 1:6500 BROOKTREE RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9272
Mailing Address - Country:US
Mailing Address - Phone:724-299-1095
Mailing Address - Fax:
Practice Address - Street 1:6500 BROOKTREE RD
Practice Address - Street 2:SUITE 208
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9272
Practice Address - Country:US
Practice Address - Phone:724-299-1095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0171541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1780055731OtherCHILD AND ADOLESCENT PSYCHIATRIC SOLUTIONS