Healthcare Provider Details

I. General information

NPI: 1821361536
Provider Name (Legal Business Name): JENNIFER R RUBERG LSW, CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE PSYCHIATRY ML 3014
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE PSYCHIATRY ML 3014
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4788
  • Fax: 513-636-4283
Mailing address:
  • Phone: 513-636-4788
  • Fax: 513-636-4283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.1440094
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: