Provider Demographics
NPI:1376668830
Name:RUBENS, LOLA
Entity Type:Individual
Prefix:
First Name:LOLA
Middle Name:
Last Name:RUBENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 FOLKSTONE CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2848
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2200 N CANTON CENTER RD
Practice Address - Street 2:SUITE 200B
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-5065
Practice Address - Country:US
Practice Address - Phone:734-981-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL8612261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical