Provider Demographics
NPI:1598017485
Name:RUBANG, CHRYSTAL ANGELINA
Entity Type:Individual
Prefix:MRS
First Name:CHRYSTAL
Middle Name:ANGELINA
Last Name:RUBANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRYSTAL
Other - Middle Name:ANGELINA
Other - Last Name:MCCORKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1563 N MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-2983
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1563 N MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-2983
Practice Address - Country:US
Practice Address - Phone:808-343-1844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor