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General NPI Number Information
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NPI Number | 1629513957
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Entity Type | Organization
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Legal Business Name | RUBINO AND REYNOLDS PSYCHOLOGY GROUP LLC
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Dates
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Enumeration Date | 12/22/2016
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Last Update Date | 12/22/2016
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Provider Practice Location Address
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Address Line | 9840 MAIN ST STE 201
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City | FAIRFAX
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State | VA
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Zip | 22031-3909
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Country | US
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Telephone | 703-547-3509
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Fax |
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Provider Business Mailing Address
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Address Line | 9840 MAIN ST STE 201
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City | FAIRFAX
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State | VA
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Zip | 22031-3909
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | JADE RUBINO
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Credential |
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Telephone | 703-547-3509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 0904009717
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License Number State | VA
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