Provider Demographics
NPI:1043770852
Name:RUBIN, ALISA GAYLE FISHMAN (LCSW, ACM)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:GAYLE FISHMAN
Last Name:RUBIN
Suffix:
Gender:F
Credentials:LCSW, ACM
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:
Other - Last Name:FISHMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2650 RIDGE AVE STE 1223
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:847-982-6715
Mailing Address - Fax:
Practice Address - Street 1:2151 WAUKEGAN RD STE 100
Practice Address - Street 2:
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1885
Practice Address - Country:US
Practice Address - Phone:847-444-5300
Practice Address - Fax:847-267-1429
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA736901041C0700X
IL1490257241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical