Provider Demographics
NPI:1548473234
Name:RUBIN, LAWRENCE C (PHD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:C
Last Name:RUBIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 NE 19TH AVE
Mailing Address - Street 2:204
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3059
Mailing Address - Country:US
Mailing Address - Phone:954-728-8360
Mailing Address - Fax:954-728-8360
Practice Address - Street 1:941 NE 19TH AVE
Practice Address - Street 2:204
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3059
Practice Address - Country:US
Practice Address - Phone:954-728-8360
Practice Address - Fax:954-728-8360
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 4524103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist