Healthcare Provider Details

I. General information

NPI: 1558298778
Provider Name (Legal Business Name): MIRIAM RUBINSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3323 AVENUE K
BROOKLYN NY
11210-4142
US

IV. Provider business mailing address

3323 AVENUE K
BROOKLYN NY
11210-4142
US

V. Phone/Fax

Practice location:
  • Phone: 917-374-6362
  • Fax:
Mailing address:
  • Phone: 917-374-6362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102575
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: