Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | NY |
NPI | 1073158689 |
---|---|
Provider Name | Vanda Rudez |
First Address | Jefferson Valley, NY 10535-0402 |
Second Address | Mohegan Lake, NY 10547-1913 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2019 |
Last Update Date | 07/11/2019 |