Healthcare Provider Details

I. General information

NPI: 1245734870
Provider Name (Legal Business Name): SHIRLEY GEDNEY-RUBEL MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 PHILLIPS LN
DARIEN CT
06820-3126
US

IV. Provider business mailing address

160 WOOSTER ST
SHELTON CT
06484-6062
US

V. Phone/Fax

Practice location:
  • Phone: 203-898-2806
  • Fax:
Mailing address:
  • Phone: 203-685-6135
  • Fax: 203-902-1060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4170
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: