Provider Demographics
NPI:1457042939
Name:RUBIO, ANJELICA CHRISTIN
Entity Type:Individual
Prefix:MS
First Name:ANJELICA
Middle Name:CHRISTIN
Last Name:RUBIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 OAK ST
Mailing Address - Street 2:
Mailing Address - City:GARWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07027-1123
Mailing Address - Country:US
Mailing Address - Phone:908-644-8650
Mailing Address - Fax:
Practice Address - Street 1:95 FARLEY AVE
Practice Address - Street 2:
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1004
Practice Address - Country:US
Practice Address - Phone:646-260-3875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician