Provider Demographics
NPI:1538454962
Name:LUBA NAKHUTINA COMPREHENSIVE PSYCHOLOGY SERVICES P.C.
Entity type:Organization
Organization Name:LUBA NAKHUTINA COMPREHENSIVE PSYCHOLOGY SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUBA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKHUTINA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:917-470-1336
Mailing Address - Street 1:ONE GRAND CENTRAL PLACE
Mailing Address - Street 2:305 MADISON AVENUE, SUITE 1060
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10165
Mailing Address - Country:US
Mailing Address - Phone:917-470-1336
Mailing Address - Fax:
Practice Address - Street 1:305 MADISON AVE STE 1060
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10165-1060
Practice Address - Country:US
Practice Address - Phone:917-470-1336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-14
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Single Specialty
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Single Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Single Specialty