Provider Demographics
NPI:1063421055
Name:DUBIN, BETTINA ZOE (PHD)
Entity type:Individual
Prefix:DR
First Name:BETTINA
Middle Name:ZOE
Last Name:DUBIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:BETTINA
Other - Middle Name:ZOE
Other - Last Name:ALDELBERG-DUBIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:4131 SPICEWOOD SPRINGS RD
Mailing Address - Street 2:SUITE E-2
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8661
Mailing Address - Country:US
Mailing Address - Phone:512-343-8307
Mailing Address - Fax:512-452-7282
Practice Address - Street 1:4131 SPICEWOOD SPRINGS RD
Practice Address - Street 2:SUITE E-2
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8661
Practice Address - Country:US
Practice Address - Phone:512-343-8307
Practice Address - Fax:512-452-7282
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-1995103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00DC08OtherBCBS ID
TX00DC08OtherBCBS ID
82985PMedicare ID - Type Unspecified