Provider Demographics
NPI:1568179851
Name:RUBIN, MALLORY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MALLORY
Middle Name:
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 1:100 MORSE ST STE 220
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-4679
Mailing Address - Country:US
Mailing Address - Phone:781-762-1419
Mailing Address - Fax:781-440-9142
Practice Address - Street 1:100 MORSE ST STE 220
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-4679
Practice Address - Country:US
Practice Address - Phone:781-762-1419
Practice Address - Fax:781-440-9142
Is Sole Proprietor?:No
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2285301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical