Healthcare Provider Details

I. General information

NPI: 1780560813
Provider Name (Legal Business Name): ORRIN KRUBLIT LGMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 DOBBIN RD STE D
COLUMBIA MD
21045-4770
US

IV. Provider business mailing address

12341 SWEETBOUGH CT
NORTH POTOMAC MD
20878-4745
US

V. Phone/Fax

Practice location:
  • Phone: 410-730-2385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLGM1126
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: