MEDICARE: CLARE RUDOLPH LCSW

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	101Y00000X	Counselor
2	1041C0700X	Clinical Social Worker	115989	CA

General Provider Information

NPI Number	:	1568915528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARE RUDOLPH LCSW

Provider Business Mailing Address
First Line	:	225 BROADWAY STE 2070
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10007-3260
Country	:	US
Telephone Number	:	212-227-4343
Fax Number	:

Provider Business Practice Location Address
First Line	:	2485 CLAY ST STE 104
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-1874
Country	:	US
Telephone Number	:	415-329-2882
Fax Number	:

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

Provider Enumeration Date	:	07/26/2016
Last Update Date	:	11/01/2024

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Directions to “ CLARE RUDOLPH LCSW” Practice Location

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