Provider Demographics
NPI:1417422494
Name:RUBIN, CARLY E (LMFT)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:E
Last Name:RUBIN
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 1:1962 NW KEARNEY ST STE 305
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1459
Mailing Address - Country:US
Mailing Address - Phone:503-770-4060
Mailing Address - Fax:
Practice Address - Street 1:1962 NW KEARNEY ST STE 305
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1459
Practice Address - Country:US
Practice Address - Phone:503-770-4060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist