Provider Demographics
NPI:1871793463
Name:RAPPAPORT, BRUCE WARD (MDIV, MED, NCC)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:WARD
Last Name:RAPPAPORT
Suffix:
Gender:M
Credentials:MDIV, MED, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MAN O WAR DR
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5215
Mailing Address - Country:US
Mailing Address - Phone:610-565-1936
Mailing Address - Fax:
Practice Address - Street 1:5235 W WOODMILL DR
Practice Address - Street 2:SUITES 47 & 48
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-4068
Practice Address - Country:US
Practice Address - Phone:302-995-1680
Practice Address - Fax:302-995-1790
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000378101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health