Provider Demographics
NPI:1659320521
Name:RUBENSTEIN, ALICE K (EDD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:K
Last Name:RUBENSTEIN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 ALLENS CREEK ROAD, SUITE 170
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3309
Mailing Address - Country:US
Mailing Address - Phone:585-271-5940
Mailing Address - Fax:585-271-3405
Practice Address - Street 1:160 ALLENS CREEKD RAD, SUITE 170
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3309
Practice Address - Country:US
Practice Address - Phone:585-271-5940
Practice Address - Fax:585-271-3405
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0051251103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7153250OtherAETNA
9291OtherBLUE CROSS BLUE SHIELD
12997OtherDISABILITY
97076OtherGHI
P010005125OtherBLUE CHOICE
NY01478064Medicaid
261341OtherMHN
100171FCOtherPREFERRED CARE
NY01478064Medicaid