Provider Demographics
NPI:1578769519
Name:RUPERTUS, KATHLEEN MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MARIE
Last Name:RUPERTUS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SILVERSIDE RD
Mailing Address - Street 2:SUITE 145
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-1374
Mailing Address - Country:US
Mailing Address - Phone:302-388-7515
Mailing Address - Fax:
Practice Address - Street 1:501 SILVERSIDE RD
Practice Address - Street 2:SUITE 145
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-1374
Practice Address - Country:US
Practice Address - Phone:302-388-7515
Practice Address - Fax:302-798-7277
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor