MEDICARE: JOHN 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
1	1041C0700X	Clinical Social Worker	079187-01	NY

General Provider Information

NPI Number	:	1891364337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN RUBIN LCSW

Provider Business Mailing Address
First Line	:	415 CENTRAL PARK W APT 6A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-4813
Country	:	US
Telephone Number	:	917-821-4188
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 CENTRAL PARK W APT 6A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-4813
Country	:	US
Telephone Number	:	917-821-4188
Fax Number	:

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

Provider Enumeration Date	:	06/20/2021
Last Update Date	:	06/20/2021

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