Provider Demographics
NPI:1629294293
Name:KRISTIANSEN-RUBIN, DAWN HELENE (LCAT)
Entity Type:Individual
Prefix:PROF
First Name:DAWN
Middle Name:HELENE
Last Name:KRISTIANSEN-RUBIN
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 BARKIT KENNEL RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-7210
Mailing Address - Country:US
Mailing Address - Phone:845-635-3137
Mailing Address - Fax:
Practice Address - Street 1:64 BARKIT KENNEL RD
Practice Address - Street 2:
Practice Address - City:PLEASANT VALLEY
Practice Address - State:NY
Practice Address - Zip Code:12569-7210
Practice Address - Country:US
Practice Address - Phone:845-635-3137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000925221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist