Provider Demographics
NPI:1235228057
Name:RUBIN, JEFFREY SCOTT (LCSWC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:SCOTT
Last Name:RUBIN
Suffix:
Gender:M
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 KLEE MILL RD S
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-9230
Mailing Address - Country:US
Mailing Address - Phone:410-552-6633
Mailing Address - Fax:
Practice Address - Street 1:5420 KLEE MILL RD S
Practice Address - Street 2:SUITE 6
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-9230
Practice Address - Country:US
Practice Address - Phone:410-552-6633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD070991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD52497404OtherCAREFIRST BCBS
MD52497404OtherCAREFIRST BCBS