MEDICARE: CYNTHIA W. LUBOW LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	23666	CA

General Provider Information

NPI Number	:	1306626189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA W. LUBOW LMFT

Provider Business Mailing Address
First Line	:	554 BEVERLY AVE
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-1930
Country	:	US
Telephone Number	:	510-334-2341
Fax Number	:

Provider Business Practice Location Address
First Line	:	554 BEVERLY AVE
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-1930
Country	:	US
Telephone Number	:	510-334-2341
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2023
Last Update Date	:	09/29/2023

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