Healthcare Provider Details

I. General information

NPI: 1578065355
Provider Name (Legal Business Name): PAUL KENNETH RUBENSTEIN MSW, LGSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E WEST HWY
SILVER SPRING MD
20910-6247
US

IV. Provider business mailing address

1215 E WEST HWY
SILVER SPRING MD
20910-6247
US

V. Phone/Fax

Practice location:
  • Phone: 202-309-3409
  • Fax:
Mailing address:
  • Phone: 202-309-3409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number23406
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: