| Lisa Lubin, Ph.d., L.l.c. | |
| 
					6175 S Carson St Centennial CO 80111-6071  | |
| (303) 680-4205 | |
| (303) 680-0489 | 
| Full Name | Lisa Lubin, Ph.d., L.l.c. | 
|---|---|
| Speciality | Clinic/Center | 
| Location | 6175 S Carson St, Centennial, Colorado | 
| Authorized Official Name and Position | Lisa Robin Lubin (CLINICAL PSYCHOLOGIST) | 
| Authorized Official Contact | 3036804205 | 
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Lisa Lubin, Ph.d., L.l.c. 6175 S Carson St Centennial CO 80111-6071 Ph: (303) 680-4205  | Lisa Lubin, Ph.d., L.l.c. 6175 S Carson St Centennial CO 80111-6071 Ph: (303) 680-4205  | 
| NPI Number | 1982030110 | 
|---|---|
| Provider Enumeration Date | 09/19/2013 | 
| Last Update Date | 09/19/2013 | 
| Medicare PECOS PAC ID | 1355576711 | 
|---|---|
| Medicare Enrollment ID | O20131021001677 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1982030110 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 1489 (Colorado) | Secondary | 
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | 1489 (Colorado) | Primary | 
| Provider Name | Lisa R Lubin | 
|---|---|
| Provider Type | Practitioner - Clinical Psychologist | 
| Provider Identifiers | NPI Number: 1467517276 PECOS PAC ID: 4082639109 Enrollment ID: I20051008000257  | 
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