Individual
MARY ELLEN RUBIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
6245 SHERIDAN DR, SUITE 218, WILLIAMSVILLE, NY 14221-4834
(716) 632-5563
Mailing address
193 GETZVILLE RD, AMHERST, NY 14226-3519
(716) 632-5563
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
005749-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000507521001
BLUE CROSS
NY
Enumeration date
09/01/2005
Last updated
07/08/2007
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