| Doctor Name: | ELLEN RUBY |
| NPI Number: | 1164720306 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW, CASAC |
| License Number: | CASAC2385 |
| Business Practice Address: | 26 Club Ln Sag Harbor, NY - 119632112 |
| Business Phone Number: | 6317251769 |
| Business Fax Number: | 6317251769 |
| Mailing Address: | 26 Club Ln, SAG HARBOR |
| State: | NY |
| Postal Code: | 119632112 |
| Phone Number: | 6317251769 |
| Fax Number: | 6317251769 |
| NPI Enumeration Date: | 03/12/2011 |
| NPI Last Update Date: | 03/12/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | CASAC2385 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |