Provider Demographics
NPI:1114209624
Name:RUBIN, JILL M (LCSW)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:RUBIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 MIDDLE RIVER DR STE 410
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3561
Mailing Address - Country:US
Mailing Address - Phone:954-263-2929
Mailing Address - Fax:954-565-6178
Practice Address - Street 1:915 MIDDLE RIVER DR STE 410
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3561
Practice Address - Country:US
Practice Address - Phone:954-263-2929
Practice Address - Fax:954-565-6178
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW104911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical