Provider Demographics
NPI:1689403685
Name:BROTHERS, RUDEE LATRINA
Entity type:Individual
Prefix:
First Name:RUDEE
Middle Name:LATRINA
Last Name:BROTHERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7865 FERN HILL ST
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4006
Mailing Address - Country:US
Mailing Address - Phone:301-704-3379
Mailing Address - Fax:
Practice Address - Street 1:101 E CHARLES ST STE 208
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-4900
Practice Address - Country:US
Practice Address - Phone:478-273-9199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRBT-24365209106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician