Provider Demographics
NPI:1679784169
Name:RUBIN, CYNTHIA LAST (PHD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LAST
Last Name:RUBIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CYNTHIA
Other - Middle Name:G
Other - Last Name:LAST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:10746 STONEBRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-6413
Mailing Address - Country:US
Mailing Address - Phone:561-716-1262
Mailing Address - Fax:
Practice Address - Street 1:2499 GLADES RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7209
Practice Address - Country:US
Practice Address - Phone:561-955-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4425103TC2200X, 103TB0200X, 103T00000X, 103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73694Medicare UPIN