Provider Demographics
NPI:1104126705
Name:RUBANO, DOUGLAS MICHAEL (LCSW)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:MICHAEL
Last Name:RUBANO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2881 CLARK RD
Mailing Address - Street 2:UNIT #11
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-6296
Mailing Address - Country:US
Mailing Address - Phone:941-315-5999
Mailing Address - Fax:
Practice Address - Street 1:2881 CLARK RD
Practice Address - Street 2:UNIT #11
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-6296
Practice Address - Country:US
Practice Address - Phone:941-315-5999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2016-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082234-11041C0700X
FLSW 131341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical