Provider Demographics
NPI:1730352360
Name:DUBOW, ERIC F (PHD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:F
Last Name:DUBOW
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:822 EAST MERRY STREET PSYCHOLOGICAL SERVICES CENTER
Mailing Address - Street 2:300 PSYCHOLOGY BUILDING, BOWLING GREEN STATE UNIVERSITY
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43403-0232
Mailing Address - Country:US
Mailing Address - Phone:419-372-2540
Mailing Address - Fax:419-372-2533
Practice Address - Street 1:822 EAST MERRY STREET PSYCHOLOGICAL SERVICES CENTER
Practice Address - Street 2:300 PSYCHOLOGY BUILDING, BOWLING GREEN STATE UNIVERSITY
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43403-0232
Practice Address - Country:US
Practice Address - Phone:419-372-2540
Practice Address - Fax:419-372-2533
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3792103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0705599Medicaid
OH0705599Medicaid