Provider Demographics
NPI:1326041005
Name:RUBIN, SETH ISAIAH (PHD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:ISAIAH
Last Name:RUBIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3118
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94966-3118
Mailing Address - Country:US
Mailing Address - Phone:415-771-5115
Mailing Address - Fax:415-887-9412
Practice Address - Street 1:2019A WEBSTER ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2329
Practice Address - Country:US
Practice Address - Phone:415-771-5115
Practice Address - Fax:415-887-9412
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 7097103T00000X, 103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No103T00000XBehavioral Health & Social Service ProvidersPsychologist