Healthcare Provider Details

I. General information

NPI: 1972442648
Provider Name (Legal Business Name): ROSE LUBIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W FRANKLIN ST
HAGERSTOWN MD
21740-4832
US

IV. Provider business mailing address

329 WASHINGTON AVE
BROOKLYN PARK MD
21225-3642
US

V. Phone/Fax

Practice location:
  • Phone: 240-315-2652
  • Fax:
Mailing address:
  • Phone: 240-315-2652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR242796
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: