Provider Demographics
NPI:1649369620
Name:RUBIN, NANCY BYRD (PSYD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:BYRD
Last Name:RUBIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2033
Mailing Address - Country:US
Mailing Address - Phone:312-409-9196
Mailing Address - Fax:847-981-0878
Practice Address - Street 1:415 E GOLF RD
Practice Address - Street 2:SUITE 115
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4078
Practice Address - Country:US
Practice Address - Phone:847-981-0860
Practice Address - Fax:947-981-0878
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005115103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL398030Medicare ID - Type Unspecified