Provider Demographics
NPI:1578794889
Name:DUBENKO, LYNN MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:MARIE
Last Name:DUBENKO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:MARIE
Other - Last Name:VOGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:3020 CHILDRENS WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4223
Mailing Address - Country:US
Mailing Address - Phone:858-576-1700
Mailing Address - Fax:858-966-8495
Practice Address - Street 1:3020 CHILDRENS WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4223
Practice Address - Country:US
Practice Address - Phone:858-576-1700
Practice Address - Fax:858-966-8495
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22882103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT40271FOtherMEDI-CAL
CAZZZH3702ZOtherBLUE SHIELD
CA053303Medicare UPIN