Provider Demographics
NPI:1417327081
Name:RUBOLINO, DEBORAH (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:RUBOLINO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 GRANDE BLVD SE STE 4045
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1755
Mailing Address - Country:US
Mailing Address - Phone:505-896-7100
Mailing Address - Fax:505-342-5414
Practice Address - Street 1:2300 GRANDE BLVD SE STE 4045
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1755
Practice Address - Country:US
Practice Address - Phone:505-896-7100
Practice Address - Fax:505-342-5414
Is Sole Proprietor?:No
Enumeration Date:2015-09-25
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-09256104100000X
NMC111281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM23270764Medicaid