Provider Demographics
NPI:1174655112
Name:LUBIN, REBECCA HEITLER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:HEITLER
Last Name:LUBIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 LOGAN ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-3130
Mailing Address - Country:US
Mailing Address - Phone:303-831-4288
Mailing Address - Fax:303-831-4286
Practice Address - Street 1:899 LOGAN ST
Practice Address - Street 2:SUITE 209
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-3130
Practice Address - Country:US
Practice Address - Phone:303-831-4288
Practice Address - Fax:303-831-4286
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1994103TC0700X, 103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07019946Medicaid
CO07019946Medicaid
COC65366Medicare ID - Type Unspecified