NPIMap

Organization Active NPI

Angela Rudner Psychotherapy LLC

  • Clinical Social Worker
  • Providence, RI
National Provider Identifier
1114378098
Registry record updated Jun 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
ISW02235 Issued in RI
Legal business name
ANGELA RUDNER PSYCHOTHERAPY LLC
Practice address
1 Richmond SQ
Ste152 E
Providence, RI 02906-5139
Phone
(401) 573-9905
NPI assigned
Jun 22, 2016
Last updated
Jun 22, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Angela Susan Rudner, LICSWNPI 1831408558
Title
President
Phone
(401) 573-9905

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X ISW02235 RI Primary
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X 116924 MA
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X 15954 MD

Addresses

Primary practice location

1 Richmond SQ
Ste152 E
Providence, RI 02906-5139

Mailing address

2 Regency PLZ Apt 1212
Providence, RI 02903-3156
Phone (410) 370-0076

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161019000478 RI Part B Supplier - Clinic/Group Practice 3779871082 Receives reassigned benefits from 1 practitioner
Practice locations: Providence, RI

National Provider Directory

National Provider Directory

Locations

1 Richmond Sq
Ste 128C
Providence, RI 02906
Phone (401) 548-8733

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1466553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466553600000",
    "number": "1114378098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 REGENCY PLZ APT 1212",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029033156",
            "telephone_number": "410-370-0076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 RICHMOND SQ",
            "address_2": "STE152 E",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029065139",
            "telephone_number": "401-573-9905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGELA RUDNER PSYCHOTHERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-22",
        "last_updated": "2016-06-22",
        "status": "A",
        "authorized_official_last_name": "RUDNER",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "SUSAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "401-573-9905",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": "ISW02235",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "116924",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "15954",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.