Provider Demographics
NPI:1518971985
Name:RUBLOFF, SARA KROLL (MS)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:KROLL
Last Name:RUBLOFF
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13720 SPRINGDALE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1353
Mailing Address - Country:US
Mailing Address - Phone:410-730-0122
Mailing Address - Fax:301-854-0898
Practice Address - Street 1:5054 DORSEY HALL DR
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7744
Practice Address - Country:US
Practice Address - Phone:410-730-0122
Practice Address - Fax:301-854-0898
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD090671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD200SMedicare ID - Type Unspecified