Healthcare Provider Details

I. General information

NPI: 1245418805
Provider Name (Legal Business Name): SHERRY GOTTESMANN RUBIN LCSW, BCD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHERRY GOTTESMANN RUBIN LCSW, BCD

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W WELSH POOL RD SUITE #4
EXTON PA
19341-1200
US

IV. Provider business mailing address

50 W WELSH POOL RD SUITE #4
EXTON PA
19341-1200
US

V. Phone/Fax

Practice location:
  • Phone: 610-873-0815
  • Fax:
Mailing address:
  • Phone: 610-873-0815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW004170L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: