Provider Demographics
NPI:1154785723
Name:NANCY E LUBOW PHD LPC MT- BC
Entity type:Organization
Organization Name:NANCY E LUBOW PHD LPC MT- BC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:LUBOW
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LPC MT-BC
Authorized Official - Phone:267-261-9987
Mailing Address - Street 1:1110 N WEST END BLVD
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-4107
Mailing Address - Country:US
Mailing Address - Phone:267-261-9987
Mailing Address - Fax:
Practice Address - Street 1:1110 N WEST END BLVD
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-4107
Practice Address - Country:US
Practice Address - Phone:267-261-9987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003389101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11688809OtherCAQH
PA825986000Medicaid
PAPC003389OtherCOMMONWEALTH OF PA
PA06717OtherMTBC