Provider Demographics
NPI:1932302940
Name:RUBINSON, AUDREY (LPC)
Entity type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:
Last Name:RUBINSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3273
Mailing Address - Country:US
Mailing Address - Phone:203-713-8989
Mailing Address - Fax:203-713-8990
Practice Address - Street 1:247 BROAD ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3273
Practice Address - Country:US
Practice Address - Phone:203-713-8989
Practice Address - Fax:203-713-8990
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001877101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008038190Medicaid
CT008038190Medicaid
CT008022622Medicaid
CT004082260Medicaid