Provider Demographics
NPI:1366627333
Name:LUBY, LUANNE (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:LUANNE
Middle Name:
Last Name:LUBY
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3948 3RD ST S
Mailing Address - Street 2:218
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-5847
Mailing Address - Country:US
Mailing Address - Phone:904-516-0225
Mailing Address - Fax:904-212-1780
Practice Address - Street 1:3948 3RD ST S
Practice Address - Street 2:218
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-5847
Practice Address - Country:US
Practice Address - Phone:904-516-0225
Practice Address - Fax:904-212-1780
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-06-2758103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst