Provider Demographics
NPI:1134612120
Name:RUBIN, BRITT (SUD-1)
Entity type:Individual
Prefix:
First Name:BRITT
Middle Name:
Last Name:RUBIN
Suffix:
Gender:F
Credentials:SUD-1
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:BRITT
Other - Last Name:RUBIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SUD-1
Mailing Address - Street 1:815 BUENA VISTA AVE W
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-4108
Mailing Address - Country:US
Mailing Address - Phone:415-967-7059
Mailing Address - Fax:415-558-4235
Practice Address - Street 1:815 BUENA VISTA AVE W
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-4108
Practice Address - Country:US
Practice Address - Phone:415-967-7059
Practice Address - Fax:415-558-4235
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)