Provider Demographics
NPI:1104949924
Name:RAPPAPORT, BRAD (PSYD)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:
Last Name:RAPPAPORT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8378 SIX FORKS RD
Mailing Address - Street 2:SUITE # 204
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615
Mailing Address - Country:US
Mailing Address - Phone:917-297-5261
Mailing Address - Fax:
Practice Address - Street 1:8378 SIX FORKS RD STE 204
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5092
Practice Address - Country:US
Practice Address - Phone:917-297-5261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015843103TC0700X
NC4483103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical