Provider Demographics
NPI:1750193041
Name:CITRENBAUM, BRYAN DROGIN
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:DROGIN
Last Name:CITRENBAUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 W LOMBARD ST APT 501
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1631
Mailing Address - Country:US
Mailing Address - Phone:301-787-0783
Mailing Address - Fax:
Practice Address - Street 1:12530 FAIRWOOD PKWY STE 102
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-6357
Practice Address - Country:US
Practice Address - Phone:301-615-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician