Provider Demographics
NPI:1891595138
Name:FIRSTEIN-RUDDER, MICHAEL (LMSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:FIRSTEIN-RUDDER
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:MR
Other - First Name:MISHA
Other - Middle Name:
Other - Last Name:FIRSTEIN-RUDDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1619 3RD AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3459
Mailing Address - Country:US
Mailing Address - Phone:212-860-8500
Mailing Address - Fax:
Practice Address - Street 1:1619 3RD AVE STE 202
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3459
Practice Address - Country:US
Practice Address - Phone:646-450-9690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1239421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical