=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871793463
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRUCE WARD RAPPAPORT M.DIV., M.ED., NCC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2007
-----------------------------------------------------
Last Update Date | 07/20/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5235 W WOODMILL DR SUITES 47 & 48
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19808-4068
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-995-1680
-----------------------------------------------------
Fax | 302-995-1790
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 MAN O WAR DR
-----------------------------------------------------
City | MEDIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19063-5215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-565-1936
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | PC-0000378
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | PC-0000378
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------