Healthcare Provider Details

I. General information

NPI: 1285439927
Provider Name (Legal Business Name): RBGL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2407 W ROGERS AVE
BALTIMORE MD
21209-4321
US

IV. Provider business mailing address

2407 W ROGERS AVE
BALTIMORE MD
21209-4321
US

V. Phone/Fax

Practice location:
  • Phone: 443-824-4535
  • Fax:
Mailing address:
  • Phone: 443-824-4535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RACHAEL GLICK
Title or Position: OWNER/MANAGING MEMBER
Credential: LCSW-C
Phone: 443-824-4535