Provider Demographics
NPI:1740376789
Name:LUBKEMAN-SMITH, LISA (LISW)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:LUBKEMAN-SMITH
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:LUBKEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:445 E. GRANVILLE RD
Mailing Address - Street 2:BLDG N
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3192
Mailing Address - Country:US
Mailing Address - Phone:614-293-9550
Mailing Address - Fax:614-293-9549
Practice Address - Street 1:445 E. GRANVILLE RD
Practice Address - Street 2:BLDG N
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3192
Practice Address - Country:US
Practice Address - Phone:614-293-9550
Practice Address - Fax:614-293-9549
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI49701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSW75642Medicare ID - Type Unspecified
OHS35835Medicare UPIN