Provider Demographics
NPI:1427400472
Name:RUBERT, MARY LOU (PHD)
Entity Type:Individual
Prefix:
First Name:MARY LOU
Middle Name:
Last Name:RUBERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11538 OLDE TIVERTON CIR
Mailing Address - Street 2:APT. 104
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20194-1950
Mailing Address - Country:US
Mailing Address - Phone:703-309-3488
Mailing Address - Fax:
Practice Address - Street 1:US GOVERNMENT
Practice Address - Street 2:HUMAN RESOURCE MANAGEMENT
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20505-0001
Practice Address - Country:US
Practice Address - Phone:703-374-1342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4522103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical