Provider Demographics
NPI:1730235656
Name:RUBIN, GAIL (LICSW)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:RUBIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1689 BEACON ST
Mailing Address - Street 2:OFFICE 1
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445
Mailing Address - Country:US
Mailing Address - Phone:617-264-2233
Mailing Address - Fax:617-332-0143
Practice Address - Street 1:1689 BEACON ST
Practice Address - Street 2:OFFICE 1
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445
Practice Address - Country:US
Practice Address - Phone:617-264-2233
Practice Address - Fax:617-332-0143
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1007961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP21372Medicare ID - Type Unspecified