Provider Demographics
NPI:1740590611
Name:RUBIN, MARSHALL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARSHALL
Middle Name:
Last Name:RUBIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 E CORONADO DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-1515
Mailing Address - Country:US
Mailing Address - Phone:520-577-7718
Mailing Address - Fax:520-577-8543
Practice Address - Street 1:4131 E CORONADO DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-1515
Practice Address - Country:US
Practice Address - Phone:520-577-7718
Practice Address - Fax:520-577-8543
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-22621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical