Provider Demographics
NPI:1629742374
Name:LUBER, BREENA
Entity Type:Individual
Prefix:
First Name:BREENA
Middle Name:
Last Name:LUBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2470 WASHINGTON AVE SPC 4
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-5935
Mailing Address - Country:US
Mailing Address - Phone:510-963-0226
Mailing Address - Fax:
Practice Address - Street 1:1301 REDWOOD WAY
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-1107
Practice Address - Country:US
Practice Address - Phone:707-806-9921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician