Healthcare Provider Details

I. General information

NPI: 1285782490
Provider Name (Legal Business Name): JERRY LUBLIN PHD VICTORIA BEECH LUBLIN PHD PSYCH ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2007
Last Update Date: 08/22/2020
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 Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA BEECH LUBLIN
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 516-466-1090