Provider Demographics
NPI:1366580698
Name:LUBRANO, SUSAN (OT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:LUBRANO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 N. STATION PLAZA
Mailing Address - Street 2:SUITE 309
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-482-2650
Mailing Address - Fax:516-466-8717
Practice Address - Street 1:45 N. STATION PLAZA
Practice Address - Street 2:SUITE 309
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021
Practice Address - Country:US
Practice Address - Phone:516-482-2650
Practice Address - Fax:516-466-8717
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000810-1225X00000X
NY00810252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist