Provider Demographics
NPI:1588863302
Name:RUBIO, ROSE MARY (SOCIAL WORKER)
Entity type:Individual
Prefix:MS
First Name:ROSE
Middle Name:MARY
Last Name:RUBIO
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 UNION CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR CREEK
Mailing Address - State:TX
Mailing Address - Zip Code:78612-3111
Mailing Address - Country:US
Mailing Address - Phone:512-985-6169
Mailing Address - Fax:
Practice Address - Street 1:185 UNION CHAPEL RD
Practice Address - Street 2:
Practice Address - City:CEDAR CREEK
Practice Address - State:TX
Practice Address - Zip Code:78612-3111
Practice Address - Country:US
Practice Address - Phone:512-985-6169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXO1947104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK2464483Medicaid