Provider Demographics
NPI:1285036798
Name:BRUBAKER, RICHARD (LMSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:BRUBAKER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 E BASELINE RD STE 130
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2487
Mailing Address - Country:US
Mailing Address - Phone:480-776-7155
Mailing Address - Fax:
Practice Address - Street 1:2451 E BASELINE RD STE 200
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2405
Practice Address - Country:US
Practice Address - Phone:480-507-2213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-13809104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker