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General NPI Number Information
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NPI Number | 1578769519
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Entity Type | Individual
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Provider Name | KATHLEEN MARIE RUPERTUS PSYD
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Gender | Female
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 08/04/2024
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Provider Practice Location Address
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Address Line | 501 SILVERSIDE RD SUITE 145
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City | WILMINGTON
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State | DE
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Zip | 19809-1374
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Country | US
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Telephone | 302-388-7515
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Fax | 302-798-7277
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Provider Business Mailing Address
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Address Line | 405 SILVERSIDE RD STE 204
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City | WILMINGTON
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State | DE
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Zip | 19809-1768
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Country | US
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Telephone | 302-388-7515
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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 | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | B1-0001139
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License Number State | DE
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