Provider Demographics
NPI:1003095134
Name:GOLUB, LYDIA ZBOROWSKI (PHD)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:ZBOROWSKI
Last Name:GOLUB
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:LESIA
Other - Last Name:ZBOROWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 NASSAU RD
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-2005
Mailing Address - Country:US
Mailing Address - Phone:973-655-9472
Mailing Address - Fax:973-655-9472
Practice Address - Street 1:50 UPPER MONTCLAIR PLZ STE 209
Practice Address - Street 2:
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1320
Practice Address - Country:US
Practice Address - Phone:973-655-9472
Practice Address - Fax:973-655-9472
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00356200103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ35SI00356200OtherMEDICAL LICENSE #