Provider Demographics
NPI:1184225385
Name:RUBENFELD, ELLEN (LPC CEAP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:RUBENFELD
Suffix:
Gender:F
Credentials:LPC CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 GANNET CT
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-4011
Mailing Address - Country:US
Mailing Address - Phone:860-912-6769
Mailing Address - Fax:
Practice Address - Street 1:186 GANNET CT
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-4011
Practice Address - Country:US
Practice Address - Phone:860-912-6769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00001187101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty