Individual provider Active NPI

Wendy K. Rudder, LCSW

  • Clinical Social Worker
  • Kingston, NY
National Provider Identifier
1417088790
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
070930 Issued in NY
Practice address
159 Green St
RM. 22
Kingston, NY 12401-3736
Phone
(845) 338-2980
Fax
(845) 338-2980
NPI assigned
Mar 8, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 070930 NY Primary

Addresses

Primary practice location

159 Green St
RM. 22
Kingston, NY 12401-3736

Mailing address

11 Tina Dr
Gardiner, NY 12525-5412
Phone (845) 255-0436

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Jewish Federation of Ulster County Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1417088790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 TINA DR",
            "city": "GARDINER",
            "state": "NY",
            "postal_code": "125255412",
            "telephone_number": "845-255-0436",
            "fax_number": "845-255-0436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 GREEN ST",
            "address_2": "RM. 22",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124013736",
            "telephone_number": "845-338-2980",
            "fax_number": "845-338-2980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDDER",
        "first_name": "WENDY",
        "middle_name": "K.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "070930",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingston, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.