Provider Demographics
NPI:1003422023
Name:RUBERTONE, CECELIA A
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:A
Last Name:RUBERTONE
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 1:9813 GARTRELL PL
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-3743
Mailing Address - Country:US
Mailing Address - Phone:301-742-5574
Mailing Address - Fax:
Practice Address - Street 1:9813 GARTRELL PL
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-3743
Practice Address - Country:US
Practice Address - Phone:301-742-5574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP10701101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor