Provider Demographics
NPI:1487679114
Name:RUDKO, REBECCA ANNE (MED)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:RUDKO
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CHARLES DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-1016
Mailing Address - Country:US
Mailing Address - Phone:508-541-7995
Mailing Address - Fax:508-346-3069
Practice Address - Street 1:89 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MEDWAY
Practice Address - State:MA
Practice Address - Zip Code:02053-1828
Practice Address - Country:US
Practice Address - Phone:508-533-3777
Practice Address - Fax:508-346-3069
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5052101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM0980OtherBC/BS PROVIDER NUMBER
MA200132025-01OtherPACIFICARE PROVIDER NUMBE
MA1034500OtherFALLON PROVIDER NUMBER