Provider Demographics
NPI:1316358617
Name:REUBIN, ANDREA R (MSW)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:R
Last Name:REUBIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4567 W PINE BLVD
Mailing Address - Street 2:#729
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2168
Mailing Address - Country:US
Mailing Address - Phone:314-750-7501
Mailing Address - Fax:
Practice Address - Street 1:4567 W PINE BLVD
Practice Address - Street 2:#729
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2168
Practice Address - Country:US
Practice Address - Phone:314-750-7501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140107101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical