Provider Demographics
NPI:1417000126
Name:RUBENSTEIN, EDWARD (PHD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:RUBENSTEIN
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 1:255 SAGES WAY
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:NC
Mailing Address - Zip Code:28753-5711
Mailing Address - Country:US
Mailing Address - Phone:828-253-0643
Mailing Address - Fax:828-253-7766
Practice Address - Street 1:255 SAGES WAY
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:NC
Practice Address - Zip Code:28753-5711
Practice Address - Country:US
Practice Address - Phone:828-253-0643
Practice Address - Fax:828-253-7766
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1460103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0375AOtherBCBS
NC6000025Medicaid
NC6000025Medicaid