Healthcare Provider Details

I. General information

NPI: 1588164073
Provider Name (Legal Business Name): RACHAEL LAUREN RANA-RUBY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHAEL LAUREN RUBY LCSW

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 02/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 N GATEWAY AVE UNIT 2
HARRIMAN TN
37748-8709
US

IV. Provider business mailing address

1850 SPRING CITY HWY
ROCKWOOD TN
37854-5951
US

V. Phone/Fax

Practice location:
  • Phone: 865-882-2010
  • Fax:
Mailing address:
  • Phone: 865-203-8048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6226
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6226
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: