Provider Demographics
NPI:1063776813
Name:RUBINO, STEPHANIE LAUREN (MS)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LAUREN
Last Name:RUBINO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-6636
Mailing Address - Country:US
Mailing Address - Phone:631-968-1171
Mailing Address - Fax:
Practice Address - Street 1:155 3RD AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6636
Practice Address - Country:US
Practice Address - Phone:631-968-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool