Provider Demographics
NPI:1467517276
Name:LUBIN, LISA ROBIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ROBIN
Last Name:LUBIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6175 S CARSON ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-6071
Mailing Address - Country:US
Mailing Address - Phone:303-680-4205
Mailing Address - Fax:303-680-0489
Practice Address - Street 1:6175 S CARSON ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-6071
Practice Address - Country:US
Practice Address - Phone:303-680-4205
Practice Address - Fax:303-680-0489
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1489103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC8861-6Medicare UPIN