Provider Demographics
NPI:1023740750
Name:RUBBE, NICOLE REGINA (LBS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:REGINA
Last Name:RUBBE
Suffix:
Gender:F
Credentials:LBS
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:REGINA
Other - Last Name:AMENDOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 BROOK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:HARRISON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:15636-1311
Mailing Address - Country:US
Mailing Address - Phone:412-913-0460
Mailing Address - Fax:
Practice Address - Street 1:1405 SHADY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-1350
Practice Address - Country:US
Practice Address - Phone:412-420-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000777101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health