MEDICARE: DR. LOUISE B LUBIN PHD

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	103T00000X	Psychologist	988	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080901	OTHER	VA	OPTIMA
2	066749	OTHER	VA	ANTHEM

General Provider Information

NPI Number	:	1659474617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUISE B LUBIN PHD

Provider Business Mailing Address
First Line	:	425 W 20TH ST STE 5
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23517-2128
Country	:	US
Telephone Number	:	757-625-1020
Fax Number	:	757-625-0244

Provider Business Practice Location Address
First Line	:	425 W 20TH ST STE 5
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23517-2128
Country	:	US
Telephone Number	:	757-625-1020
Fax Number	:	757-625-0244

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	07/12/2010

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