Provider Demographics
NPI:1841327053
Name:RUBIN, MARK STEPHEN (LCSW)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:STEPHEN
Last Name:RUBIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 COLLEGE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401
Mailing Address - Country:US
Mailing Address - Phone:802-651-7512
Mailing Address - Fax:802-860-0183
Practice Address - Street 1:156 COLLEGE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401
Practice Address - Country:US
Practice Address - Phone:802-651-7512
Practice Address - Fax:802-860-0183
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900004621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical