Rudolph, Ann M

Rudolph, Ann M is an sole proprietor health care provider with primary practice located at 1000 Main St , Port Jefferson NY 11777-2250. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Rudolph, Ann M can be contacted via phone (631) 331-4458.

Contact Information

Primary practice address
1000 Main St Port Jefferson NY 11777-2250
Phone: (631) 331-4458
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X R037202-1 New York

Profile Details

NPI number 1417013723
LBN Legal business name Rudolph, Ann M
Credentials L-CSW-R
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 29th, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417013723 NPPES
New York Other 5169741 AETNA
New York Other P1626359 AETNA
New York Other 071480 AETNA
New York Other 7404242 AETNA
New York Other 13690 AETNA

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