Provider Demographics
NPI:1851517197
Name:RUBIN, ELLEN I (PSYD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:I
Last Name:RUBIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522
Mailing Address - Country:US
Mailing Address - Phone:914-263-4115
Mailing Address - Fax:914-479-0574
Practice Address - Street 1:21 W 86TH ST
Practice Address - Street 2:SUITE 209
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3616
Practice Address - Country:US
Practice Address - Phone:212-721-5546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY 010624103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist