MEDICARE: DR. MARILYN LUBER PH.D.

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	103TC0700X	Clinical Psychologist	PS004942L	PA

General Provider Information

NPI Number	:	1558354480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARILYN LUBER PH.D.

Provider Business Mailing Address
First Line	:	255 S 17TH ST
Second Line	:	SUITE 804
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6231
Country	:	US
Telephone Number	:	215-545-8296
Fax Number	:	215-545-7245

Provider Business Practice Location Address
First Line	:	255 S 17TH ST
Second Line	:	SUITE 804
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6231
Country	:	US
Telephone Number	:	215-545-8296
Fax Number	:	215-545-7245

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	07/08/2007

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