MEDICARE: MR. MARK LAWRENCE DUBIN LCSW

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	1041C0700X	Clinical Social Worker	SW8010	FL

General Provider Information

NPI Number	:	1942498837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK LAWRENCE DUBIN LCSW

Provider Business Mailing Address
First Line	:	5767 WASHINGTON ST APT F21
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33023-1494
Country	:	US
Telephone Number	:	954-961-1890
Fax Number	:

Provider Business Practice Location Address
First Line	:	5767 WASHINGTON ST APT F21
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33023-1494
Country	:	US
Telephone Number	:	954-961-1890
Fax Number	:

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

Provider Enumeration Date	:	10/05/2007
Last Update Date	:	10/16/2007

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