Healthcare Provider Details

I. General information

NPI: 1629949680
Provider Name (Legal Business Name): KEREN RUBIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 HURLBUT ST
ALBANY NY
12209-2111
US

IV. Provider business mailing address

42 HURLBUT ST
ALBANY NY
12209-2111
US

V. Phone/Fax

Practice location:
  • Phone: 203-962-2592
  • Fax:
Mailing address:
  • Phone: 203-962-2592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number099174
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: