Provider Demographics
NPI:1437452570
Name:RUBIN, DEVORA LEE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DEVORA
Middle Name:LEE
Last Name:RUBIN
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 1:15 NW PARK PLACE, SUITE 130 CROSSWATERS FAMILY THERAPY
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703
Mailing Address - Country:US
Mailing Address - Phone:541-610-8391
Mailing Address - Fax:541-726-5085
Practice Address - Street 1:15 NW PARK PLACE, SUITE 130 CROSSWATERS FAMILY THERAPY
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703
Practice Address - Country:US
Practice Address - Phone:541-610-8391
Practice Address - Fax:541-726-5085
Is Sole Proprietor?:No
Enumeration Date:2010-12-12
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21871041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR164936Medicaid
ORR0000WDBCHOtherMEDICARE GROUP