MEDICARE: LOUISE B. LUBIN, PH.D. LTD

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	261QM0850X	Adult Mental Health Clinic/Center	0810000988	VA

General Provider Information

NPI Number	:	1972768513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUISE B. LUBIN, PH.D. LTD

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

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LOUISE B. LUBIN
Credential	:	PH.D.
Telephone Number	:	757-625-1020

Provider Enumeration Date	:	07/23/2008
Last Update Date	:	07/23/2008

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