Provider Demographics
NPI:1952961062
Name:LUBIN, AUDREY (PSYD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:LUBIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 VALLEY RD APT C2
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1872
Mailing Address - Country:US
Mailing Address - Phone:929-324-7342
Mailing Address - Fax:
Practice Address - Street 1:551 VALLEY RD # 189
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1832
Practice Address - Country:US
Practice Address - Phone:929-324-7342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022056103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist