Healthcare Provider Details

I. General information

NPI: 1578769519
Provider Name (Legal Business Name): KATHLEEN MARIE RUPERTUS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 08/04/2024
Certification Date: 08/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SILVERSIDE RD SUITE 145
WILMINGTON DE
19809-1374
US

IV. Provider business mailing address

405 SILVERSIDE RD STE 204
WILMINGTON DE
19809-1768
US

V. Phone/Fax

Practice location:
  • Phone: 302-388-7515
  • Fax: 302-798-7277
Mailing address:
  • Phone: 302-388-7515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberB1-0001139
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: