Healthcare Provider Details

I. General information

NPI: 1265353502
Provider Name (Legal Business Name): AVIGAYIL RUBANOWITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 BELLONA LN STE 203
TOWSON MD
21204-2066
US

IV. Provider business mailing address

6000 STUART AVE
BALTIMORE MD
21209-4020
US

V. Phone/Fax

Practice location:
  • Phone: 410-777-8151
  • Fax:
Mailing address:
  • Phone: 424-335-9039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number35178
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: