Provider Demographics
NPI:1467505677
Name:DUBIN, LISA S (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:S
Last Name:DUBIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 LAS VEGAS BLVD NORTH
Mailing Address - Street 2:NELLIS AFB HOSPITAL
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89014
Mailing Address - Country:US
Mailing Address - Phone:347-920-1420
Mailing Address - Fax:
Practice Address - Street 1:1408 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1231
Practice Address - Country:US
Practice Address - Phone:347-920-1420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7371-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1467505677Medicaid