Provider Demographics
NPI:1578690442
Name:LUBITZ, DIANA RAE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:RAE
Last Name:LUBITZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:95524-0146
Mailing Address - Country:US
Mailing Address - Phone:707-443-3384
Mailing Address - Fax:
Practice Address - Street 1:2265 BUTTERMILK LN
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6924
Practice Address - Country:US
Practice Address - Phone:707-382-9277
Practice Address - Fax:707-822-7777
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28308101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1308500Medicaid