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General NPI Number Information
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NPI Number | 1124453402
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Entity Type | Individual
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Provider Name | JOYCE MATTHEWS-RURAK PH.D.
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Gender | Female
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Dates
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Enumeration Date | 09/05/2013
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Last Update Date | 09/05/2013
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Provider Practice Location Address
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Address Line | 417 EMMET STREET SOUTH
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22904-4270
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Country | US
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Telephone | 434-924-7034
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Fax | 434-924-4621
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Provider Business Mailing Address
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Address Line | 417 EMMET STREET SOUTH P.O. BOX 400270
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22904-4270
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Country | US
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Telephone | 434-924-7034
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Fax | 434-924-4621
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810004802
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License Number State | VA
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