Healthcare Provider Details

I. General information

NPI: 1841066545
Provider Name (Legal Business Name): MS. KELLY LYNN RUBIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3251 N MCMULLEN BOOTH RD STE 100
CLEARWATER FL
33761-2022
US

IV. Provider business mailing address

2995 DREW ST
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 727-725-6026
  • Fax:
Mailing address:
  • Phone: 727-315-7496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH11521
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: