Provider Demographics
NPI:1275265886
Name:RUBINO, LIA JACQUELINE (BS)
Entity Type:Individual
Prefix:
First Name:LIA
Middle Name:JACQUELINE
Last Name:RUBINO
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:LI
Other - Middle Name:JACQUELINE
Other - Last Name:RUBINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS
Mailing Address - Street 1:275 S GARDEN WAY APT 326
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-5947
Mailing Address - Country:US
Mailing Address - Phone:732-354-6445
Mailing Address - Fax:
Practice Address - Street 1:260 E 11TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3247
Practice Address - Country:US
Practice Address - Phone:541-484-4428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health