MEDICARE: DR. SETH ISAIAH RUBIN 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	103T00000X	Psychologist	PSY 7097	CA
2	103TP0814X	Psychoanalysis Psychologist	PSY 7097	CA

General Provider Information

NPI Number	:	1326041005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SETH ISAIAH RUBIN PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 3118
Second Line	:
City	:	SAUSALITO
State	:	CA
Zip	:	94966-3118
Country	:	US
Telephone Number	:	415-771-5115
Fax Number	:	415-887-9412

Provider Business Practice Location Address
First Line	:	2019A WEBSTER ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-2329
Country	:	US
Telephone Number	:	415-771-5115
Fax Number	:	415-887-9412

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/16/2009

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