Healthcare Provider Details

I. General information

NPI: 1841780152
Provider Name (Legal Business Name): ANNA RUBIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11565 LAUREL CANYON BLVD STE 218
SAN FERNANDO CA
91340
US

IV. Provider business mailing address

23055 SHERMAN WAY UNIT 4953
WEST HILLS CA
91308-7056
US

V. Phone/Fax

Practice location:
  • Phone: 818-256-2358
  • Fax:
Mailing address:
  • Phone: 818-851-0427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number77516
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: