Provider Demographics
NPI:1932323573
Name:RUDD, ROBIN A (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:A
Last Name:RUDD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 SAINT ELMO AVE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-6019
Mailing Address - Country:US
Mailing Address - Phone:301-652-3290
Mailing Address - Fax:
Practice Address - Street 1:4915 SAINT ELMO AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-6019
Practice Address - Country:US
Practice Address - Phone:301-652-3290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD2216103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist