Provider Demographics
NPI:1124458377
Name:BAUBLITZ-RUPP, GINA (MSW)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:BAUBLITZ-RUPP
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:BAUBLITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:309 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32951-2605
Mailing Address - Country:US
Mailing Address - Phone:321-952-0649
Mailing Address - Fax:
Practice Address - Street 1:1037 PATHFINDER WAY
Practice Address - Street 2:SUITE 130
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3242
Practice Address - Country:US
Practice Address - Phone:321-639-1224
Practice Address - Fax:321-636-0800
Is Sole Proprietor?:No
Enumeration Date:2013-11-24
Last Update Date:2013-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker