MEDICARE: DR. NANCY L RUBEL 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	4557	OH

General Provider Information

NPI Number	:	1699744698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY L RUBEL PH.D.

Provider Business Mailing Address
First Line	:	1395 OAKRIDGE DR
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44121-1667
Country	:	US
Telephone Number	:	216-410-3667
Fax Number	:

Provider Business Practice Location Address
First Line	:	3659 GREEN RD STE 100
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-5715
Country	:	US
Telephone Number	:	216-462-0530
Fax Number	:

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	01/30/2020

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