Provider Demographics
NPI:1578669396
Name:RUBENSTEIN, ELAINE M (PHD LCSWC)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:M
Last Name:RUBENSTEIN
Suffix:
Gender:F
Credentials:PHD LCSWC
Other - Prefix:MRS
Other - First Name:ELAINE
Other - Middle Name:R
Other - Last Name:LEAVERTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD LCSWC
Mailing Address - Street 1:1331 KINLOCH CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012
Mailing Address - Country:US
Mailing Address - Phone:410-647-8210
Mailing Address - Fax:410-647-8267
Practice Address - Street 1:1331 KINLOCH CIRCLE
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012
Practice Address - Country:US
Practice Address - Phone:410-647-8210
Practice Address - Fax:410-647-8267
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01340104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD252L423BMedicare ID - Type Unspecified