Provider Demographics
NPI:1659852416
Name:DR JENNIFER RUBOLINO LMHC
Entity Type:Organization
Organization Name:DR JENNIFER RUBOLINO LMHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MBR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUBOLINO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:954-821-9291
Mailing Address - Street 1:22684 VISTAWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428
Mailing Address - Country:US
Mailing Address - Phone:954-821-9291
Mailing Address - Fax:866-757-5778
Practice Address - Street 1:205 WORTH AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33480
Practice Address - Country:US
Practice Address - Phone:954-821-9291
Practice Address - Fax:866-757-5778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-28
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14608101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty