Provider Demographics
NPI:1972768513
Name:LOUISE B. LUBIN, PH.D. LTD
Entity Type:Organization
Organization Name:LOUISE B. LUBIN, PH.D. LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:B
Authorized Official - Last Name:LUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:757-625-1020
Mailing Address - Street 1:425 W 20TH ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-2128
Mailing Address - Country:US
Mailing Address - Phone:757-625-1020
Mailing Address - Fax:757-625-0244
Practice Address - Street 1:425 W 20TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-2128
Practice Address - Country:US
Practice Address - Phone:757-625-1020
Practice Address - Fax:757-625-0244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000988261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA620000115Medicare PIN