Provider Demographics
NPI:1518358035
Name:URBINA, LUIS
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:URBINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 MILLBURY ST APT 209
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-2895
Mailing Address - Country:US
Mailing Address - Phone:508-450-2866
Mailing Address - Fax:
Practice Address - Street 1:190 MILLBURY ST APT 209
Practice Address - Street 2:411 CHANDLER ST
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-2895
Practice Address - Country:US
Practice Address - Phone:508-450-2866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor