Provider Demographics
NPI:1427076017
Name:RUBIN, ELIZABETH B (MS, LCSW)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:B
Last Name:RUBIN
Suffix:
Gender:F
Credentials:MS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WATER ST
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2861
Mailing Address - Country:US
Mailing Address - Phone:203-458-0661
Mailing Address - Fax:203-458-6068
Practice Address - Street 1:25 WATER ST
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2861
Practice Address - Country:US
Practice Address - Phone:203-458-0661
Practice Address - Fax:203-458-6068
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0019911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800000153Medicare UPIN