Provider Demographics
NPI:1427448638
Name:REYNOLDS & RUBINO PSYCHOLOGY GROUP, LLC
Entity type:Organization
Organization Name:REYNOLDS & RUBINO PSYCHOLOGY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/CLIN PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JADE
Authorized Official - Middle Name:TIU
Authorized Official - Last Name:RUBINO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:703-547-3509
Mailing Address - Street 1:10301 DEMOCRACY LN STE 201
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2545
Mailing Address - Country:US
Mailing Address - Phone:703-547-3509
Mailing Address - Fax:703-383-3887
Practice Address - Street 1:10301 DEMOCRACY LN STE 201
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2545
Practice Address - Country:US
Practice Address - Phone:703-547-3509
Practice Address - Fax:703-383-3887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA081004478103TC0700X
VA0810004777103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty