Active NPI
Jordan Elizabeth Rudolph
- Clinical Social Worker
- Charlotte, NC
National Provider Identifier
1932550662
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 5700 Executive Center Dr
Charlotte, NC 28212-8858 - Phone
- (704) 525-3255
- NPI assigned
- Jun 23, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | CA | ||
| Mental Health Counselor | 101YM0800X | |||
| Social Worker | 104100000X | CA | ||
| Clinical Social Worker | 1041C0700X | Primary |
Addresses
Primary practice location
5700 Executive Center Dr
Charlotte, NC 28212-8858
Mailing address
5700 Executive Center Dr
Charlotte, NC 28212-8858
Phone (704) 525-3255
Other practice location 1
902 S Myrtle Ave
2nd Floor
Monrovia, CA 91016
Phone (626) 463-1021 ext. 1105
Other practice location 2
3455 Percy St
Los Angeles, CA 90023
Phone (323) 268-2100 ext. 1105
Other practice location 3
3455 Percy St
Los Angeles, CA 90023
Phone (323) 268-2100 ext. 1105
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1466640000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581724800000",
"number": "1932550662",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5700 EXECUTIVE CENTER DR",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282128858",
"telephone_number": "704-525-3255"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5700 EXECUTIVE CENTER DR",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282128858",
"telephone_number": "704-525-3255"
}
],
"practiceLocations": [
{
"address_1": "902 S Myrtle Ave",
"address_2": "2nd Floor",
"address_purpose": "LOCATION",
"city": "Monrovia",
"state": "CA",
"postal_code": "91016",
"country_code": "US",
"telephone_number": "626-463-1021 x1105",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3455 Percy St",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "90023",
"country_code": "US",
"telephone_number": "323-268-2100 x1105",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3455 Percy St",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "90023",
"country_code": "US",
"telephone_number": "323-268-2100 x1105",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "RUDOLPH",
"first_name": "JORDAN",
"middle_name": "ELIZABETH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-06-23",
"last_updated": "2020-02-15",
"certification_date": "2020-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "CA",
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CA",
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.