Provider Demographics
NPI:1891352878
Name:RUDYAKOVA, MARINA (MS)
Entity Type:Individual
Prefix:MS
First Name:MARINA
Middle Name:
Last Name:RUDYAKOVA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 BAY 34TH ST APT 1G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-5711
Mailing Address - Country:US
Mailing Address - Phone:917-420-1935
Mailing Address - Fax:
Practice Address - Street 1:243 BAY 34TH ST APT 1G
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-5711
Practice Address - Country:US
Practice Address - Phone:917-420-1935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool