Healthcare Provider Details

I. General information

NPI: 1124442546
Provider Name (Legal Business Name): ANGELICA RUBIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 ANGELICA CT
WEST BABYLON NY
11704-8501
US

IV. Provider business mailing address

3 ANGELICA CT
WEST BABYLON NY
11704-8501
US

V. Phone/Fax

Practice location:
  • Phone: 347-741-6228
  • Fax:
Mailing address:
  • Phone: 347-741-6228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number099143
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: