Provider Demographics
NPI:1629459599
Name:RUBIN, REBECCA MARIE (LCAT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name: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 1:190 N 10TH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-9317
Mailing Address - Country:US
Mailing Address - Phone:617-880-9211
Mailing Address - Fax:
Practice Address - Street 1:190 N 10TH ST STE 301
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-9317
Practice Address - Country:US
Practice Address - Phone:617-880-9211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001885101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor