Judith Rutberg-Self, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

3453 Issued in WA

Practice address

793 Ericksen Ave NE Ste 123
Bainbridge Island
Bainbridge Island, WA 98110-1877

Phone

(206) 478-8104

NPI assigned

Jan 15, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1841341948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "793 ERICKSEN AVE NE STE 123",
            "address_2": "BAINBRIDGE ISLAND",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "981101877",
            "telephone_number": "206-478-8104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "793 ERICKSEN AVE NE STE 123",
            "address_2": "BAINBRIDGE ISLAND",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "981101877",
            "telephone_number": "206-478-8104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUTBERG-SELF",
        "first_name": "JUDITH",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WA",
            "license": "3453",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Bainbridge Island, WA
• Providers in Bainbridge Island, WA by specialty
• Psychologist in Washington

• 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.