Provider Demographics
NPI:1295890655
Name:DUBIN, WILLIAM (PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:DUBIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 EDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-2336
Mailing Address - Country:US
Mailing Address - Phone:914-834-1362
Mailing Address - Fax:
Practice Address - Street 1:44 EDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-2336
Practice Address - Country:US
Practice Address - Phone:914-834-1362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1933-1103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV29011Medicare ID - Type Unspecified