Provider Demographics
NPI:1568536704
Name:RUBIN, JILL ZOE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:ZOE
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 1:30 5TH AVE
Mailing Address - Street 2:APT. 14D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8859
Mailing Address - Country:US
Mailing Address - Phone:212-677-1461
Mailing Address - Fax:
Practice Address - Street 1:80 UNIVERSITY PL
Practice Address - Street 2:SUITE 3
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4564
Practice Address - Country:US
Practice Address - Phone:212-677-1461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR013001-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPR013001-1OtherSOCIAL WORK LICENSE NUMBE
NYN01621Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER