=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699834960
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELLEN G RUDERMAN PHD PSYD LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16055 VENTURA BLVD STE 1110
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-784-7090
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16055 VENTURA BLVD STE 1110
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-784-7090
-----------------------------------------------------
Fax | 818-981-3477
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TP0814X
-----------------------------------------------------
Taxonomy Name | Psychoanalysis Psychologist
-----------------------------------------------------
License Number | CERTIFICATE
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 000241
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------