Provider Demographics
NPI:1831107382
Name:RUBIN, BARRY (LCSW)
Entity Type:Individual
Prefix:
First Name:BARRY
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 1:75 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-1396
Mailing Address - Country:US
Mailing Address - Phone:207-974-6090
Mailing Address - Fax:
Practice Address - Street 1:75 LONGVIEW DR
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-1396
Practice Address - Country:US
Practice Address - Phone:207-974-6090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC7021041C0700X
CT136011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME223450199Medicaid