Provider Demographics
NPI:1942498837
Name:DUBIN, MARK LAWRENCE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:LAWRENCE
Last Name:DUBIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5767 WASHINGTON ST APT F21
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33023-1494
Mailing Address - Country:US
Mailing Address - Phone:954-961-1890
Mailing Address - Fax:
Practice Address - Street 1:5767 WASHINGTON ST APT F21
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33023-1494
Practice Address - Country:US
Practice Address - Phone:954-961-1890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW80101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical