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General NPI Number Information
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NPI Number | 1952893356
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Entity Type | Organization
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Legal Business Name | STEVE RUBIN
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 4740 N STATE ROAD 7 STE 201
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33319-5839
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Country | US
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Telephone | 954-777-1630
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Fax |
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Provider Business Mailing Address
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Address Line | 22257 COLLINGTON DR
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City | BOCA RATON
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State | FL
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Zip | 33428-4727
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Country | US
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Telephone | 561-239-2244
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Fax | 561-516-8866
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. STEVE RUBIN
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Credential | LCSW, MCAP
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Telephone | 561-239-2244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | SW13356
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | SW13356
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License Number State | FL
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