Provider Demographics
NPI:1225416704
Name:RUBENSTEIN, ANDREA
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:RUBENSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 FRANKLIN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-3734
Mailing Address - Country:US
Mailing Address - Phone:510-200-8878
Mailing Address - Fax:
Practice Address - Street 1:66 FRANKLIN ST STE 300
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-3734
Practice Address - Country:US
Practice Address - Phone:105-200-8878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-15
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31977103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program