Provider Demographics
NPI:1073128799
Name:RUBINO, JAYDEN S (TLMFT)
Entity Type:Individual
Prefix:
First Name:JAYDEN
Middle Name:S
Last Name:RUBINO
Suffix:
Gender:F
Credentials:TLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4237 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-4976
Mailing Address - Country:US
Mailing Address - Phone:319-504-1829
Mailing Address - Fax:
Practice Address - Street 1:403 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2840
Practice Address - Country:US
Practice Address - Phone:319-260-2149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA100526106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist