Provider Demographics
NPI:1558805564
Name:LUBIN, FABRICE ROBERT (PSYD)
Entity Type:Individual
Prefix:
First Name:FABRICE
Middle Name:ROBERT
Last Name:LUBIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1564 N DAMEN AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2102
Mailing Address - Country:US
Mailing Address - Phone:954-559-0073
Mailing Address - Fax:773-409-5008
Practice Address - Street 1:1564 N DAMEN AVE STE 208
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2102
Practice Address - Country:US
Practice Address - Phone:773-888-1681
Practice Address - Fax:773-409-5008
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-09
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009410103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical