Healthcare Provider Details

I. General information

NPI: 1952459091
Provider Name (Legal Business Name): VICTORIA BEECH LUBLIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 E 68TH ST
NEW YORK NY
10021-4903
US

IV. Provider business mailing address

9 AVALON RD
GREAT NECK NY
11021-3901
US

V. Phone/Fax

Practice location:
  • Phone: 212-628-9200
  • Fax: 212-472-7253
Mailing address:
  • Phone: 516-466-1090
  • Fax: 516-466-1090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number007800-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: