Provider Demographics
NPI:1043220171
Name:RUBIN, MICHELLE (CSW)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:
Last Name:RUBIN
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 KATHY PL
Mailing Address - Street 2:APT 2D
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5925
Mailing Address - Country:US
Mailing Address - Phone:718-983-8872
Mailing Address - Fax:718-983-0348
Practice Address - Street 1:172 RAVENHURST AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-2664
Practice Address - Country:US
Practice Address - Phone:718-983-8872
Practice Address - Fax:718-983-0348
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05370311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN6H501Medicare ID - Type Unspecified