Provider Demographics
NPI:1487687554
Name:RUBILLO, NANCY N
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:N
Last Name:RUBILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BUSH ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-6542
Mailing Address - Country:US
Mailing Address - Phone:843-546-6816
Mailing Address - Fax:
Practice Address - Street 1:14323 OCEAN HIGHWAY
Practice Address - Street 2:SUITE 4111
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-4817
Practice Address - Country:US
Practice Address - Phone:843-235-9960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical