Provider Demographics
NPI:1619329356
Name:MARJORIE J. RUBIN, MA, LMHC, PLLC
Entity Type:Organization
Organization Name:MARJORIE J. RUBIN, MA, LMHC, PLLC
Other - Org Name:BAINBRIDGE COMMUNITY COUNSELING PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHX
Authorized Official - Phone:206-842-4898
Mailing Address - Street 1:PO BOX 10064
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-0064
Mailing Address - Country:US
Mailing Address - Phone:206-842-4898
Mailing Address - Fax:
Practice Address - Street 1:793 ERICKSEN AVE NE
Practice Address - Street 2:SUITE 123-A
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1876
Practice Address - Country:US
Practice Address - Phone:206-842-4898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60581536101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty