Provider Demographics
NPI:1245431790
Name:RUBIN, SIMONE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SIMONE
Middle Name:
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 1:2128 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-3847
Mailing Address - Country:US
Mailing Address - Phone:215-740-0768
Mailing Address - Fax:215-487-1992
Practice Address - Street 1:6012 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1643
Practice Address - Country:US
Practice Address - Phone:217-487-1990
Practice Address - Fax:215-487-1992
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0151301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA042558Medicare ID - Type Unspecified