Provider Demographics
NPI:1285292847
Name:LUBIN, KECHNER
Entity type:Individual
Prefix:
First Name:KECHNER
Middle Name:
Last Name:LUBIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 LONGWOOD AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-6577
Mailing Address - Country:US
Mailing Address - Phone:617-792-1716
Mailing Address - Fax:
Practice Address - Street 1:21 LONGWOOD AVE APT 3
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-6577
Practice Address - Country:US
Practice Address - Phone:617-792-1716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health