Healthcare Provider Details

I. General information

NPI: 1144914243
Provider Name (Legal Business Name): ALEXANDRA G RUBIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 THAYER CTR STE C
OAKLAND MD
21550-1139
US

IV. Provider business mailing address

18120 CHALET DR APT 104
GERMANTOWN MD
20874-5875
US

V. Phone/Fax

Practice location:
  • Phone: 240-785-0212
  • Fax:
Mailing address:
  • Phone: 240-785-0212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP8314
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP8314
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: