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General NPI Number Information
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NPI Number | 1114378098
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Entity Type | Organization
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Legal Business Name | ANGELA RUDNER PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 06/22/2016
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Last Update Date | 06/22/2016
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Provider Practice Location Address
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Address Line | 1 RICHMOND SQ STE152 E
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City | PROVIDENCE
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State | RI
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Zip | 02906-5139
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Country | US
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Telephone | 401-573-9905
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Fax |
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Provider Business Mailing Address
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Address Line | 2 REGENCY PLZ APT 1212
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City | PROVIDENCE
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State | RI
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Zip | 02903-3156
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Country | US
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Telephone | 410-370-0076
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ANGELA SUSAN RUDNER
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Credential | LICSW
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Telephone | 401-573-9905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 116924
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 15954
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW02235
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License Number State | RI
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