Provider Demographics
NPI:1285899492
Name:RUBRUM, ERICA (LMFT)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:RUBRUM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BRYANT AVE
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1105
Mailing Address - Country:US
Mailing Address - Phone:516-621-1698
Mailing Address - Fax:516-625-3289
Practice Address - Street 1:50 BRYANT AVE
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1105
Practice Address - Country:US
Practice Address - Phone:516-621-1698
Practice Address - Fax:516-625-3289
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YS0200X
NY000194106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000194OtherNYS LICENSE