Healthcare Provider Details

I. General information

NPI: 1861890964
Provider Name (Legal Business Name): CHRISTIN BUBERT LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6707 WHITESTONE RD
WOODLAWN MD
21207-4106
US

IV. Provider business mailing address

407 CENTRAL AVE
REISTERSTOWN MD
21136-1854
US

V. Phone/Fax

Practice location:
  • Phone: 410-265-8737
  • Fax:
Mailing address:
  • Phone: 410-517-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20008
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: