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NPI Code Detail

MEDICARE: REBECCA RUBEN MSW, LCSW

MEDICARE:   REBECCA  RUBEN  MSW, LCSW
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
1104100000XSocial Worker71477CA
21041C0700XClinical Social Worker98965CA

General Provider Information

NPI Number : 1336692763
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA RUBEN MSW, LCSW
Provider Business Mailing Address
First Line : 1741 SILVER LAKE BLVD STE 2B
Second Line :
City : LOS ANGELES
State : CA
Zip : 90026-1256
Country : US
Telephone Number : 781-910-9456
Fax Number :
Provider Business Practice Location Address
First Line : 1741 SILVER LAKE BLVD STE 2B
Second Line :
City : LOS ANGELES
State : CA
Zip : 90026-1256
Country : US
Telephone Number : 781-910-9456
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2016
Last Update Date : 10/26/2022

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