Provider Demographics
NPI:1730232000
Name:ROYTBURD, LUBA ALEXANDRA (PHD)
Entity type:Individual
Prefix:DR
First Name:LUBA
Middle Name:ALEXANDRA
Last Name:ROYTBURD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:730 SAINT NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-4002
Mailing Address - Country:US
Mailing Address - Phone:646-706-7781
Mailing Address - Fax:646-706-7781
Practice Address - Street 1:11241 QUEENS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7475
Practice Address - Country:US
Practice Address - Phone:646-706-7781
Practice Address - Fax:646-706-7781
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016984-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist