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NPI Code Detail

MEDICARE: RACHEL BRUDER

MEDICARE: RACHEL BRUDER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2103TC0700XClinical PsychologistPSY1001165DC

General Provider Information

NPI Number : 1275938631
Entity Type Code : Individual
Provider Name (Legal Business Name) : RACHEL BRUDER
Provider Business Mailing Address
First Line : 1220 12TH ST SE STE 120
Second Line :
City : WASHINGTON
State : DC
Zip : 20003-3733
Country : US
Telephone Number : 202-715-7900
Fax Number :
Provider Business Practice Location Address
First Line : 1251 SARATOGA AVE NE
Second Line :
City : WASHINGTON
State : DC
Zip : 20018-1025
Country : US
Telephone Number : 202-832-8818
Fax Number : 202-548-8600
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2014
Last Update Date : 03/17/2018

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Directions to “ RACHEL BRUDER ” Practice Location

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