Provider Demographics
NPI:1609983832
Name:RUDORFER, FERN SLOVIN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:FERN
Middle Name:SLOVIN
Last Name:RUDORFER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3924 AVENUE T
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5028
Mailing Address - Country:US
Mailing Address - Phone:718-252-0958
Mailing Address - Fax:
Practice Address - Street 1:3924 AVENUE T
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5028
Practice Address - Country:US
Practice Address - Phone:718-252-0958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR021626-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health