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NPI Code Detail

MEDICARE: DR. KELLI RUBIN GOOD PH.D.

MEDICARE: DR. KELLI RUBIN GOOD PH.D.
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
1103T00000XPsychologistPPS-532882VA

General Provider Information

NPI Number : 1487146627
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELLI RUBIN GOOD PH.D.
Provider Business Mailing Address
First Line : 641 CARRIAGE HILL RD
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23452-6518
Country : US
Telephone Number : 757-263-2700
Fax Number : 757-493-5437
Provider Business Practice Location Address
First Line : 641 CARRIAGE HILL RD
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23452-6518
Country : US
Telephone Number : 757-263-2700
Fax Number : 757-493-5437
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2018
Last Update Date : 08/29/2024

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