Provider Demographics
NPI:1396566733
Name:RUDOLF, DOROTHEA L
Entity type:Individual
Prefix:
First Name:DOROTHEA
Middle Name:L
Last Name:RUDOLF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DARCIE
Other - Middle Name:
Other - Last Name:RUDOLF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:624 WASHINGTON LN
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3213
Mailing Address - Country:US
Mailing Address - Phone:215-680-8088
Mailing Address - Fax:
Practice Address - Street 1:624 WASHINGTON LN
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3213
Practice Address - Country:US
Practice Address - Phone:215-680-8088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC015202101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional