Provider Demographics
NPI:1598022022
Name:LISA M. LUBKEMAN-SMITH
Entity Type:Organization
Organization Name:LISA M. LUBKEMAN-SMITH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LUBKEMAN-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:614-404-2088
Mailing Address - Street 1:3736 N HIGH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3523
Mailing Address - Country:US
Mailing Address - Phone:614-404-2088
Mailing Address - Fax:
Practice Address - Street 1:3736 N HIGH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3523
Practice Address - Country:US
Practice Address - Phone:614-404-2088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-22
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI4970251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI4970OtherSOCIAL WORKER CLINICAL 1041C0700X
OHI4970OtherSOCIAL WORKER CLINICAL 1041C0700X
S35835Medicare UPIN