Healthcare Provider Details

I. General information

NPI: 1912290545
Provider Name (Legal Business Name): MICHELLE LYNN RUBIO LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 W ELM AVE
HANOVER PA
17331-5125
US

IV. Provider business mailing address

2930 SUNSET LN
YORK PA
17408-9561
US

V. Phone/Fax

Practice location:
  • Phone: 717-646-2951
  • Fax: 717-632-3657
Mailing address:
  • Phone: 717-792-6687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW127088
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: