Provider Demographics
NPI:1811035967
Name:RUBENSTEIN, MARTHA S (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:S
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 1:108 E MAIN ST STE 210A
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4257
Mailing Address - Country:US
Mailing Address - Phone:423-392-6898
Mailing Address - Fax:423-392-6900
Practice Address - Street 1:108 E MAIN ST STE 210A
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4257
Practice Address - Country:US
Practice Address - Phone:423-392-6898
Practice Address - Fax:423-392-6900
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1844103T00000X, 103TA0700X, 103TC1900X, 103TF0000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9213177OtherPHCS
TN086618000OtherMAGELLAN
TN283730OtherBCBS VA
TN4522650OtherAETNA
TN089489OtherVALUE OPTIONS
TN123121OtherMHN
TN3051273OtherBCBS TN
TN9213177OtherPHCS
TN086618000OtherMAGELLAN