Basic Information
| Provider Information | |||||||||
| NPI: | 1275938631 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRUDER | ||||||||
| FirstName: | RACHEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1220 12TH ST SE STE 120 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200033733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027157900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1251 SARATOGA AVE NE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200181025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028328818 | ||||||||
| FaxNumber: | 2025488600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2014 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 103TC0700X | PSY1001165 | DC | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.