Provider Demographics
NPI:1639297682
Name:CITRENBAUM, CHARLES MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MICHAEL
Last Name:CITRENBAUM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HAMILL RD.
Mailing Address - Street 2:SUITE 322
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-1813
Mailing Address - Country:US
Mailing Address - Phone:410-433-6555
Mailing Address - Fax:410-433-6565
Practice Address - Street 1:2 HAMILL RD.
Practice Address - Street 2:SUITE 322
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-1813
Practice Address - Country:US
Practice Address - Phone:410-433-6555
Practice Address - Fax:410-433-6565
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD897103T00000X, 103TA0400X, 103TC0700X, 103TC2200X, 103TE1100X, 103TF0000X, 103TF0200X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG103Medicare PIN