MEDICARE: JOAN RUBIN MA 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	106H00000X	Marriage & Family Therapist	94692	CA

General Provider Information

NPI Number	:	1477880177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN RUBIN MA LMFT

Provider Business Mailing Address
First Line	:	PO BOX 6684
Second Line	:
City	:	ALBANY
State	:	CA
Zip	:	94706-0684
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 BERKELEY PARK BLVD STE 3
Second Line	:
City	:	KENSINGTON
State	:	CA
Zip	:	94707-1244
Country	:	US
Telephone Number	:	510-545-3804
Fax Number	:

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

Provider Enumeration Date	:	11/17/2009
Last Update Date	:	11/01/2019

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