Provider Demographics
NPI:1497224919
Name:LUBETH, MICHELL (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELL
Middle Name:
Last Name:LUBETH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 WILLOUGHBY ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5257
Mailing Address - Country:US
Mailing Address - Phone:347-473-7428
Mailing Address - Fax:
Practice Address - Street 1:57 WILLOUGHBY ST FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5290
Practice Address - Country:US
Practice Address - Phone:347-473-7428
Practice Address - Fax:718-408-6599
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1538379573Medicaid