Provider Demographics
NPI:1457980187
Name:RUEDA, DALESA (LMFT)
Entity type:Individual
Prefix:DR
First Name:DALESA
Middle Name:
Last Name:RUEDA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLYN
Mailing Address - State:PA
Mailing Address - Zip Code:19094-1313
Mailing Address - Country:US
Mailing Address - Phone:484-301-0870
Mailing Address - Fax:
Practice Address - Street 1:6120 CATHARINE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-2206
Practice Address - Country:US
Practice Address - Phone:484-301-0870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-04
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000643106H00000X
DE0000040106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000040OtherLICENSE