Healthcare Provider Details

I. General information

NPI: 1760874440
Provider Name (Legal Business Name): ANTHONY L. RUBIN, MA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2015
Last Update Date: 03/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13631 W DESERT FLOWER DR
GOODYEAR AZ
85395-2222
US

IV. Provider business mailing address

13631 W DESERT FLOWER DR
GOODYEAR AZ
85395-2222
US

V. Phone/Fax

Practice location:
  • Phone: 623-935-5917
  • Fax: 623-925-5962
Mailing address:
  • Phone: 623-935-5917
  • Fax: 623-925-5962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0259
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0202
License Number StateAZ

VIII. Authorized Official

Name: ANTHONY L RUBIN
Title or Position: PRESIDENT
Credential: MA
Phone: 623-935-5917