Provider Demographics
NPI:1003246703
Name:BRUBAKER, CRISTINA CAROL (LISW-S)
Entity Type:Individual
Prefix:MS
First Name:CRISTINA
Middle Name:CAROL
Last Name:BRUBAKER
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:MS
Other - First Name:CRISTINA
Other - Middle Name:BRUBAKER
Other - Last Name:SLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:6465 REFLECTIONS DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-2377
Mailing Address - Country:US
Mailing Address - Phone:614-792-1108
Mailing Address - Fax:614-792-0018
Practice Address - Street 1:6465 REFLECTIONS DR
Practice Address - Street 2:SUITE 110
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2377
Practice Address - Country:US
Practice Address - Phone:614-792-1108
Practice Address - Fax:614-792-0018
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0002533SUPV104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker