Provider Demographics
NPI:1184626657
Name:RUBIN, RUTH E (MSW, MED, LADC)
Entity type:Individual
Prefix:MS
First Name:RUTH
Middle Name:E
Last Name:RUBIN
Suffix:
Gender:F
Credentials:MSW, MED, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 MORRILL RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05828-9301
Mailing Address - Country:US
Mailing Address - Phone:802-748-9536
Mailing Address - Fax:
Practice Address - Street 1:1091 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-9242
Practice Address - Country:US
Practice Address - Phone:902-748-8920
Practice Address - Fax:802-748-9536
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000217101YA0400X
VT08900000611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN0563Medicare ID - Type Unspecified