Provider Demographics
NPI:1417422494
Name:RUBIN, CARLY E (MA, MFTI)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:E
Last Name:RUBIN
Suffix:
Gender:F
Credentials:MA, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5703 N MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-4637
Mailing Address - Country:US
Mailing Address - Phone:152-040-9521
Mailing Address - Fax:
Practice Address - Street 1:1942 NW KEARNEY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1426
Practice Address - Country:US
Practice Address - Phone:530-395-4772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist