Provider Demographics
NPI:1316240526
Name:RUBIN, JEFFREY B (LCSW, PHD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:B
Last Name:RUBIN
Suffix:
Gender:M
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10507
Mailing Address - Country:US
Mailing Address - Phone:914-242-0229
Mailing Address - Fax:
Practice Address - Street 1:1841 BROADWAY RM 711
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7666
Practice Address - Country:US
Practice Address - Phone:212-664-0751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO2162211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical