MEDICARE: NANCY N RUBILLO

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	252	SC

General Provider Information

NPI Number	:	1487687554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY N RUBILLO

Provider Business Mailing Address
First Line	:	10 BUSH ST
Second Line	:
City	:	GEORGETOWN
State	:	SC
Zip	:	29440-6542
Country	:	US
Telephone Number	:	843-546-6816
Fax Number	:

Provider Business Practice Location Address
First Line	:	14323 OCEAN HIGHWAY
Second Line	:	SUITE 4111
City	:	PAWLEYS ISLAND
State	:	SC
Zip	:	29585-4817
Country	:	US
Telephone Number	:	843-235-9960
Fax Number	:

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	02/07/2008

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