Provider Demographics
NPI:1134161052
Name:RUBIN, BRACHA TOVA (PHD)
Entity type:Individual
Prefix:DR
First Name:BRACHA
Middle Name:TOVA
Last Name:RUBIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:TOVA
Other - Middle Name:
Other - Last Name:RUBIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 781221
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78278-1221
Mailing Address - Country:US
Mailing Address - Phone:210-697-1600
Mailing Address - Fax:210-493-6714
Practice Address - Street 1:11503 NW MILITARY HWY
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1896
Practice Address - Country:US
Practice Address - Phone:210-697-1600
Practice Address - Fax:210-493-6714
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32561103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0001MEOtherBCBS PROVIDER NUMBER
TXNP0424Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER