Provider Demographics
NPI:1871896159
Name:LUBIN, BEVERLY MAY (MA, MFT)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:MAY
Last Name:LUBIN
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 S SAN VICENTE BLVD
Mailing Address - Street 2:#206
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4647
Mailing Address - Country:US
Mailing Address - Phone:323-397-8222
Mailing Address - Fax:
Practice Address - Street 1:554 S SAN VICENTE BLVD
Practice Address - Street 2:#206
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4647
Practice Address - Country:US
Practice Address - Phone:323-397-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 40316106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist