Provider Demographics
NPI:1003461021
Name:LEUBLING, MICHAEL T (MED, LAC, NCC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:LEUBLING
Suffix:
Gender:M
Credentials:MED, LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 TIMBER LN
Mailing Address - Street 2:
Mailing Address - City:NEWFOUNDLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07435-1717
Mailing Address - Country:US
Mailing Address - Phone:973-464-6037
Mailing Address - Fax:
Practice Address - Street 1:17-07 ROMAINE ST
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2150
Practice Address - Country:US
Practice Address - Phone:201-796-9482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00484700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health