MEDICARE: ERICA RUBRUM LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YS0200X	School Counselor		NY
2	106H00000X	Marriage & Family Therapist	000194	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000194	OTHER	NY	NYS LICENSE

General Provider Information

NPI Number	:	1285899492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA RUBRUM LMFT

Provider Business Mailing Address
First Line	:	50 BRYANT AVE
Second Line	:
City	:	ROSLYN
State	:	NY
Zip	:	11576-1105
Country	:	US
Telephone Number	:	516-621-1698
Fax Number	:	516-625-3289

Provider Business Practice Location Address
First Line	:	50 BRYANT AVE
Second Line	:
City	:	ROSLYN
State	:	NY
Zip	:	11576-1105
Country	:	US
Telephone Number	:	516-621-1698
Fax Number	:	516-625-3289

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2008
Last Update Date	:	07/21/2022

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