Provider Demographics
NPI:1639206121
Name:RUBIN, GREGORY (LCPC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:RUBIN
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 KLEE MILL RD S STE 6
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-9230
Mailing Address - Country:US
Mailing Address - Phone:410-552-5290
Mailing Address - Fax:
Practice Address - Street 1:5420 KLEE MILL RD S STE 6
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-9230
Practice Address - Country:US
Practice Address - Phone:410-552-5290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1958101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD684BGAOtherCARE FIRST MD
DCK4020001OtherCARE FIRST DC