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NPI Code Detail

MEDICARE: DR. KATHLEEN MARIE RUPERTUS PSYD

MEDICARE: DR. KATHLEEN MARIE RUPERTUS PSYD
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
1103TB0200XCognitive & Behavioral PsychologistB1-0001139DE

General Provider Information

NPI Number : 1578769519
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KATHLEEN MARIE RUPERTUS PSYD
Provider Business Mailing Address
First Line : 405 SILVERSIDE RD STE 204
Second Line :
City : WILMINGTON
State : DE
Zip : 19809-1768
Country : US
Telephone Number : 302-388-7515
Fax Number :
Provider Business Practice Location Address
First Line : 501 SILVERSIDE RD
Second Line : SUITE 145
City : WILMINGTON
State : DE
Zip : 19809-1374
Country : US
Telephone Number : 302-388-7515
Fax Number : 302-798-7277
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2007
Last Update Date : 08/04/2024

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