Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 013133 | NY |
NPI | 1003982810 |
---|---|
Provider Name | Dr. Glenna B Rubin |
First Address | Elmhurst, NY 11373-1329 |
Second Address | Jamaica, NY 11432-1121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2006 |
Last Update Date | 08/07/2007 |