=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346968815
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RUBERTI COUNSELING SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2022
-----------------------------------------------------
Last Update Date | 08/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 525 S 4TH ST STE 477
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19147-1582
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-330-5830
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 525 S 4TH ST STE 477
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19147-1582
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-592-4145
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CHRISTINE BRUNING
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 609-992-4989
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------