Provider Demographics
NPI:1598267833
Name:JENNIFER LUBOSKI PHD LLC
Entity Type:Organization
Organization Name:JENNIFER LUBOSKI PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:775-525-3007
Mailing Address - Street 1:1325 AIRMOTIVE WAY STE 175
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3286
Mailing Address - Country:US
Mailing Address - Phone:775-525-3007
Mailing Address - Fax:
Practice Address - Street 1:1325 AIRMOTIVE WAY STE 175E
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3273
Practice Address - Country:US
Practice Address - Phone:775-525-3007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-02
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002432261QM0801X
261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)