Provider Demographics
NPI:1295856698
Name:LUBART, WILLIAM DANA (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DANA
Last Name:LUBART
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 1:520 W 23RD ST
Mailing Address - Street 2:APT. 5E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-1132
Mailing Address - Country:US
Mailing Address - Phone:212-627-2134
Mailing Address - Fax:
Practice Address - Street 1:450 W 24TH ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-1351
Practice Address - Country:US
Practice Address - Phone:212-627-2134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012740103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVL956Medicare ID - Type Unspecified