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General NPI Number Information
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NPI Number | 1871547653
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Entity Type | Individual
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Provider Name | AIJA LUBAVS MA
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Gender | Female
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 01/20/2011
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Provider Practice Location Address
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Address Line | 5930 LOVERS LN
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City | PORTAGE
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State | MI
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Zip | 49002-1673
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Country | US
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Telephone | 269-353-4370
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Fax | 269-344-8696
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Provider Business Mailing Address
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Address Line | 2116 ABERDEEN DR
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City | KALAMAZOO
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State | MI
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Zip | 49008-1728
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Country | US
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Telephone | 269-343-3353
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Fax | 269-344-8696
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301008381
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License Number State | MI
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