Provider Demographics
NPI:1801009311
Name:RUBIN, MADELINE ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:ELIZABETH
Last Name:RUBIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:ELIZABETH
Other - Last Name:RUBIN HEMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 1593
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339
Mailing Address - Country:US
Mailing Address - Phone:541-758-7332
Mailing Address - Fax:541-754-7459
Practice Address - Street 1:216 SW MADISON AVENUE
Practice Address - Street 2:SUITE 14
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333
Practice Address - Country:US
Practice Address - Phone:541-758-7332
Practice Address - Fax:541-754-7459
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR01751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR005076OtherVALUE OPTIONS EAP