Provider Demographics
NPI:1801942297
Name:DUBIN, MARTIN DAVID (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:DAVID
Last Name:DUBIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 E 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7071
Mailing Address - Country:US
Mailing Address - Phone:303-204-3258
Mailing Address - Fax:
Practice Address - Street 1:8000 E 6TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7071
Practice Address - Country:US
Practice Address - Phone:303-204-3258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO723103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07100019Medicaid
CO07100019Medicaid