Provider Demographics
NPI:1790715639
Name:RUBENSTEIN, SUSAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:RUBENSTEIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-2311
Mailing Address - Country:US
Mailing Address - Phone:516-353-1048
Mailing Address - Fax:516-801-0917
Practice Address - Street 1:105 HILLSIDE AVE
Practice Address - Street 2:SUITE G
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-2311
Practice Address - Country:US
Practice Address - Phone:516-294-0910
Practice Address - Fax:516-801-0917
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2010-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7099103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist