Provider Demographics
NPI:1063556553
Name:RUBEL, ELIZABETH GAYLE (PHD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:GAYLE
Last Name:RUBEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:GAYLE
Other - Last Name:CORRIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:8 DIANE LN
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1516
Mailing Address - Country:US
Mailing Address - Phone:415-608-7323
Mailing Address - Fax:
Practice Address - Street 1:8 DIANE LN
Practice Address - Street 2:
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1516
Practice Address - Country:US
Practice Address - Phone:415-608-7323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20043103TC0700X
CAPSY 20043103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical