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NPI Code Detail

MEDICARE: JILL M RUBIN LCSW

MEDICARE: JILL M RUBIN 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
11041C0700XClinical Social Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1GO183AOTHERFLPTAN

General Provider Information

NPI Number : 1538642111
Entity Type Code : Organization
Provider Name (Legal Business Name) : JILL M RUBIN LCSW
Provider Business Mailing Address
First Line : 915 MIDDLE RIVER DR STE 417
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33304-3561
Country : US
Telephone Number : 954-263-2929
Fax Number :
Provider Business Practice Location Address
First Line : 915 MIDDLE RIVER DR STE 417
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33304-3561
Country : US
Telephone Number : 954-263-2929
Fax Number :
Authorized Official
Title or Position : THERAPIST
Name : JILL RUBIN
Credential :
Telephone Number : 954-263-2929
Provider Enumeration Date : 09/10/2018
Last Update Date : 09/10/2018

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