Provider Demographics
NPI:1811184641
Name:RUBERG, REBECCA SALVATO (PHD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SALVATO
Last Name:RUBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 PALOS VERDES DR N STE 106
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-2560
Mailing Address - Country:US
Mailing Address - Phone:323-325-1566
Mailing Address - Fax:
Practice Address - Street 1:4030 PALOS VERDES DR N STE 106
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-2560
Practice Address - Country:US
Practice Address - Phone:323-325-1566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23853103TC0700X
CA060282014103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool