Active NPI
Stephen Gerald Rudin, ED.D.
- Clinical Psychologist
- Brockton, MA
National Provider Identifier
1609962976
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY-635-PR
- Practice address
- 1342 Belmont St
Suite 204
Brockton, MA 02301-4436 - Phone
- (508) 427-6911
- Fax
- (508) 588-4639
- NPI assigned
- Oct 5, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY-635-PR | MA | Primary |
Addresses
Primary practice location
1342 Belmont St
Suite 204
Brockton, MA 02301-4436
Mailing address
7301 NW 18TH St
No. 204
Margate, FL 33063-6857
Phone (954) 970-3205
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 290594 | Other | MA | MENTAL HEALTH NETWORK MHN |
| W01468 | Other | MA | BLUE SHIELD OF MASSACHUSE |
| 42279 | Other | MA | HARVARD PILGRIM HEALTH CA |
| 732869 | Other | MA | TUFTS HEALTH PLANS |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY-635-PR | MA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1609962976",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7301 NW 18TH ST",
"address_2": "NO. 204",
"city": "MARGATE",
"state": "FL",
"postal_code": "330636857",
"telephone_number": "954-970-3205",
"fax_number": "954-957-7505"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1342 BELMONT ST",
"address_2": "SUITE 204",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023014436",
"telephone_number": "508-427-6911",
"fax_number": "508-588-4639"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDIN",
"first_name": "STEPHEN",
"middle_name": "GERALD",
"name_prefix": "Dr.",
"credential": "ED.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "PY-635-PR",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MENTAL HEALTH NETWORK MHN",
"identifier": "290594",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD OF MASSACHUSE",
"identifier": "W01468",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM HEALTH CA",
"identifier": "42279",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS HEALTH PLANS",
"identifier": "732869",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
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.