MEDICARE: MICHAEL RUDZINSKI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041S0200X	School Social Worker
2	1041C0700X	Clinical Social Worker	31574	MD

General Provider Information

NPI Number	:	1043915242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL RUDZINSKI

Provider Business Mailing Address
First Line	:	2201 2ND ST NW APT 41
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20001-1639
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4905 DEL RAY AVE STE 210
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20814-2559
Country	:	US
Telephone Number	:	301-941-7730
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2023
Last Update Date	:	06/10/2024

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Directions to “ MICHAEL RUDZINSKI ” Practice Location

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