MEDICARE: SARAH RUBIN M.A., M.F.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	45221	CA

General Provider Information

NPI Number	:	1114199437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH RUBIN M.A., M.F.T.

Provider Business Mailing Address
First Line	:	PO BOX 214
Second Line	:
City	:	MOSS BEACH
State	:	CA
Zip	:	94038-0214
Country	:	US
Telephone Number	:	650-635-6888
Fax Number	:

Provider Business Practice Location Address
First Line	:	799 MAIN ST
Second Line	:	SUITE G
City	:	HALF MOON BAY
State	:	CA
Zip	:	94019-1996
Country	:	US
Telephone Number	:	650-635-6888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2008
Last Update Date	:	10/06/2011

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