Provider Demographics
NPI:1023790789
Name:RUBIO, LISBETH M (MS)
Entity type:Individual
Prefix:
First Name:LISBETH
Middle Name:M
Last Name:RUBIO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9771 SW 160TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-3346
Mailing Address - Country:US
Mailing Address - Phone:786-879-3067
Mailing Address - Fax:
Practice Address - Street 1:9245 SW 157TH ST STE 203
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1975
Practice Address - Country:US
Practice Address - Phone:786-879-3067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH24314101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health