Healthcare Provider Details

I. General information

NPI: 1225872229
Provider Name (Legal Business Name): SUSAN LAURIE RUBENFELD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 S MAIN ST
WALNUT CREEK CA
94596-5318
US

IV. Provider business mailing address

332 SKANDER LN
PLEASANT HILL CA
94523-1728
US

V. Phone/Fax

Practice location:
  • Phone: 925-295-6964
  • Fax:
Mailing address:
  • Phone: 925-998-3658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW87505
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: