Provider Demographics
NPI:1275768152
Name:RUSABROVA, YULIYA T (LCPC)
Entity Type:Individual
Prefix:
First Name:YULIYA
Middle Name:T
Last Name:RUSABROVA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12341 BONCREST DR
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-1707
Mailing Address - Country:US
Mailing Address - Phone:410-453-9553
Mailing Address - Fax:
Practice Address - Street 1:1931 GREENSPRING DR
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-4113
Practice Address - Country:US
Practice Address - Phone:410-453-9553
Practice Address - Fax:410-453-9552
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2219101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLC2219OtherSTATE LICENSE