1598022022 NPI number — LISA M. LUBKEMAN-SMITH

Table of content: (NPI 1598022022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598022022 NPI number — LISA M. LUBKEMAN-SMITH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LISA M. LUBKEMAN-SMITH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598022022
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3736 N HIGH ST
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43214-3523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-404-2088
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3736 N HIGH ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43214-3523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-404-2088
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/22/2012

Additional Information

Authorized Official

Authorized Official Last Name:
LUBKEMAN-SMITH
Authorized Official First Name:
LISA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
SOLE PROPRIETOR/THERAPIST
Authorized Official Telephone Number:
614-404-2088

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  I4970 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: I4970 . This is a "SOCIAL WORKER CLINICAL 1041C0700X" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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