Provider Demographics
NPI:1689304735
Name:LUBINETS, ELENA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:LUBINETS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 SEBEC LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIMANTIC
Mailing Address - State:ME
Mailing Address - Zip Code:04443-4321
Mailing Address - Country:US
Mailing Address - Phone:201-281-8400
Mailing Address - Fax:
Practice Address - Street 1:28 GILMAN PLZ
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3561
Practice Address - Country:US
Practice Address - Phone:207-990-0162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP3606235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty