Provider Demographics
NPI:1437637188
Name:BRAD RAPPAPORT, PSY.D., PLLC
Entity Type:Organization
Organization Name:BRAD RAPPAPORT, PSY.D., PLLC
Other - Org Name:INNER PATH PSYCHOTHERAPY & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPPAPORT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:917-297-5261
Mailing Address - Street 1:3013 GENTLE BREEZES LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-7059
Mailing Address - Country:US
Mailing Address - Phone:917-297-5261
Mailing Address - Fax:
Practice Address - Street 1:8378 SIX FORKS RD STE 204
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5092
Practice Address - Country:US
Practice Address - Phone:917-297-5261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-04
Last Update Date:2018-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4483103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty