MEDICARE: DR. JEFFREY B RUBIN LCSW, PH.D.

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	1041C0700X	Clinical Social Worker	PRO216221	NY

General Provider Information

NPI Number	:	1316240526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY B RUBIN LCSW, PH.D.

Provider Business Mailing Address
First Line	:	66 MAIN STREET
Second Line	:
City	:	BEDFORD HILLS
State	:	NY
Zip	:	10507
Country	:	US
Telephone Number	:	914-242-0229
Fax Number	:

Provider Business Practice Location Address
First Line	:	1841 BROADWAY RM 711
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10023-7666
Country	:	US
Telephone Number	:	212-664-0751
Fax Number	:

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

Provider Enumeration Date	:	12/09/2010
Last Update Date	:	12/09/2010

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