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General NPI Number Information
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NPI Number | 1548741903
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Entity Type | Individual
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Provider Name | BROOKE ASHLIE RUDOLPH
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Gender | Female
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Dates
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Enumeration Date | 08/23/2018
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 70 MURPHY RD # 300A
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City | PORT MONMOUTH
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State | NJ
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Zip | 07758-1030
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Country | US
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Telephone | 732-787-1220
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Fax |
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Provider Business Mailing Address
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Address Line | 3019 CAMELOT CT
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City | HELMETTA
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State | NJ
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Zip | 08828-2501
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Country | US
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Telephone | 732-799-9474
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 107973
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License Number State | NY
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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 | 44SL06680500
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License Number State | NJ
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