Provider Demographics
NPI:1851345359
Name:KOROBKIN, SAMUEL B (PHD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:B
Last Name:KOROBKIN
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 1:90 PAINTERS MILL RD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3630
Mailing Address - Country:US
Mailing Address - Phone:443-929-0779
Mailing Address - Fax:410-356-3376
Practice Address - Street 1:90 PAINTERS MILL RD
Practice Address - Street 2:SUITE 214
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3630
Practice Address - Country:US
Practice Address - Phone:443-929-0779
Practice Address - Fax:410-356-3376
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03986103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist