Healthcare Provider Details

I. General information

NPI: 1275938631
Provider Name (Legal Business Name): RACHEL BRUDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 SARATOGA AVE NE
WASHINGTON DC
20018-1025
US

IV. Provider business mailing address

1220 12TH ST SE STE 120
WASHINGTON DC
20003-3733
US

V. Phone/Fax

Practice location:
  • Phone: 202-832-8818
  • Fax: 202-548-8600
Mailing address:
  • Phone: 202-715-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY1001165
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: