Provider Demographics
NPI:1487374856
Name:RUBENSTEIN, KIM C (PSYD)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:C
Last Name:RUBENSTEIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 BROADVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-4801
Mailing Address - Country:US
Mailing Address - Phone:847-732-4020
Mailing Address - Fax:
Practice Address - Street 1:464 CROSS ARM DR
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2762
Practice Address - Country:US
Practice Address - Phone:224-292-8833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist