MEDICARE: LINDSAY RUDOLPH L.C.S.W.

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
1	1041C0700X	Clinical Social Worker	CW017154	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1780055731	OTHER	PA	CHILD AND ADOLESCENT PSYCHIATRIC SOLUTIONS

General Provider Information

NPI Number	:	1366861262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSAY RUDOLPH L.C.S.W.

Provider Business Mailing Address
First Line	:	6500 BROOKTREE RD
Second Line	:	SUITE 208
City	:	WEXFORD
State	:	PA
Zip	:	15090-9272
Country	:	US
Telephone Number	:	724-299-1095
Fax Number	:

Provider Business Practice Location Address
First Line	:	6500 BROOKTREE RD
Second Line	:	SUITE 208
City	:	WEXFORD
State	:	PA
Zip	:	15090-9272
Country	:	US
Telephone Number	:	724-299-1095
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2014
Last Update Date	:	11/30/2015

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Directions to “ LINDSAY RUDOLPH L.C.S.W.” Practice Location

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