Provider Demographics
NPI:1578585394
Name:ALBUKERK, LYNNE D (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:D
Last Name:ALBUKERK
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 1:4 PEMBROKE DR
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-1788
Mailing Address - Country:US
Mailing Address - Phone:516-676-3437
Mailing Address - Fax:
Practice Address - Street 1:4 PEMBROKE DR
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-1788
Practice Address - Country:US
Practice Address - Phone:516-676-3437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6861103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02024362Medicaid
NY02024362Medicaid