Provider Demographics
NPI:1093722779
Name:RUBIN, RONALD P (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:P
Last Name:RUBIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 ROCKAWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570
Mailing Address - Country:US
Mailing Address - Phone:513-763-0876
Mailing Address - Fax:718-883-6167
Practice Address - Street 1:40 ROCKAWAY AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570
Practice Address - Country:US
Practice Address - Phone:513-763-0876
Practice Address - Fax:718-883-6167
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0289551104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN33461Medicare ID - Type Unspecified