MEDICARE: DR. LIA RUDNICK PH.D.

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	106H00000X	Marriage & Family Therapist	M16588	CA

General Provider Information

NPI Number	:	1538364443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIA RUDNICK PH.D.

Provider Business Mailing Address
First Line	:	240 TAMAL VISTA BLVD
Second Line	:	SUITE 270
City	:	CORTE MADERA
State	:	CA
Zip	:	94925-1132
Country	:	US
Telephone Number	:	415-924-8786
Fax Number	:	415-924-8786

Provider Business Practice Location Address
First Line	:	264 W BALTIMORE AVE
Second Line	:
City	:	LARKSPUR
State	:	CA
Zip	:	94939-2126
Country	:	US
Telephone Number	:	415-924-2678
Fax Number	:	415-924-8786

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

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	07/08/2007

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