Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Jason Marc Rudolph, PSYD

Individual provider Clinical Psychologist · NPI 1174404016

Dr. Jason Marc Rudolph, PSYD is a Clinical Psychologist in Wainscott, New York. Licensed in California and New York. Registered with an NPI since 2025.

Licensed in
CA, NY
In the registry since
2025
Specialties on file
2
What do these letters mean?
PSYD — Doctor of Psychology
A doctoral psychologist trained primarily for clinical practice.

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Practice location Address checks out

48 S Breeze Dr
Wainscott, NY 11975
Phone: (917) 750-8400
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Psychologist (primary) Taxonomy 103TC0700X · Licence 017306 (NY)
Clinical Psychologist Taxonomy 103TC0700X · Licence 35868 (CA)

Record details

NPI number1174404016
Entity typeIndividual (Type 1)
GenderMale
Credentials PSYD
Sole proprietorNo
NPI enumeratedSeptember 9, 2025
Last updated in NPPESSeptember 9, 2025
Certification dateAugust 27, 2025

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