Provider Demographics
NPI:1659188498
Name:SIMILIEN, LUBERT
Entity type:Individual
Prefix:MR
First Name:LUBERT
Middle Name:
Last Name:SIMILIEN
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 1:1050 NW 112TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-6150
Mailing Address - Country:US
Mailing Address - Phone:786-384-6161
Mailing Address - Fax:
Practice Address - Street 1:1050 NW 112TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168-6150
Practice Address - Country:US
Practice Address - Phone:786-384-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103TH0100X
S545-520-79-372-0103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103T00000XBehavioral Health & Social Service ProvidersPsychologist