Provider Demographics
NPI:1265509780
Name:LEBOW, ARTHUR JAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:JAY
Last Name:LEBOW
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 GRAND AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55409-1233
Mailing Address - Country:US
Mailing Address - Phone:952-451-2817
Mailing Address - Fax:651-796-0206
Practice Address - Street 1:3808 GRAND AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55409-1233
Practice Address - Country:US
Practice Address - Phone:952-451-2817
Practice Address - Fax:651-796-0206
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1812103T00000X, 103TP0814X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN203250300Medicaid
MN203250300Medicaid
MN013J6LEOtherBLUECROSS BLUESHIELD
MN203250300Medicaid
MNHP84366OtherHEALTHPARTNERS
MN680000388Medicare PIN