Provider Demographics
NPI:1396417218
Name:EVA K. RUBIN, LICENSED CLINICAL SOCIAL WORKER, INC.
Entity Type:Organization
Organization Name:EVA K. RUBIN, LICENSED CLINICAL SOCIAL WORKER, INC.
Other - Org Name:WELLNESS ONLINE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:EVA
Authorized Official - Middle Name:K
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, LCSW
Authorized Official - Phone:510-858-7877
Mailing Address - Street 1:230 N MAR VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1411
Mailing Address - Country:US
Mailing Address - Phone:510-858-7877
Mailing Address - Fax:888-425-0567
Practice Address - Street 1:230 N MAR VISTA AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1411
Practice Address - Country:US
Practice Address - Phone:510-858-7877
Practice Address - Fax:888-425-0567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-29
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty