Provider Demographics
NPI:1184740755
Name:RUBIN, SHAWN ARI (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:ARI
Last Name:RUBIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 ROCHESTER RD
Mailing Address - Street 2:APT. C
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-4199
Mailing Address - Country:US
Mailing Address - Phone:248-506-5390
Mailing Address - Fax:
Practice Address - Street 1:27620 FARMINGTON RD
Practice Address - Street 2:SUITE 212
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3349
Practice Address - Country:US
Practice Address - Phone:248-506-5390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012096103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical