Provider Demographics
NPI:1417076712
Name:LUBETKIN, DEBORAH E (PSYD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:E
Last Name:LUBETKIN
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 1:1140 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7130
Mailing Address - Country:US
Mailing Address - Phone:973-276-1880
Mailing Address - Fax:
Practice Address - Street 1:1140 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7130
Practice Address - Country:US
Practice Address - Phone:973-276-1880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00339200103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical