Provider Demographics
NPI:1134383581
Name:RUDERMAN, RACHEL ANN (PSY D)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:ANN
Last Name:RUDERMAN
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 QUINAN ST
Mailing Address - Street 2:#100
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-1621
Mailing Address - Country:US
Mailing Address - Phone:510-414-9426
Mailing Address - Fax:510-295-2595
Practice Address - Street 1:668 QUINAN ST
Practice Address - Street 2:#100
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-1621
Practice Address - Country:US
Practice Address - Phone:510-414-9426
Practice Address - Fax:510-295-2595
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251S00000XAgenciesCommunity/Behavioral Health