Provider Demographics
NPI:1982487799
Name:RUBIN, ROXY RENEE
Entity Type:Individual
Prefix:
First Name:ROXY
Middle Name:RENEE
Last Name:RUBIN
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 1:160 STELLA LN
Mailing Address - Street 2:
Mailing Address - City:MORSE
Mailing Address - State:LA
Mailing Address - Zip Code:70559-2608
Mailing Address - Country:US
Mailing Address - Phone:337-384-4004
Mailing Address - Fax:
Practice Address - Street 1:1604 W PINHOOK RD STE 115
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3729
Practice Address - Country:US
Practice Address - Phone:337-335-7671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC9428101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health