Provider Demographics
NPI:1053665406
Name:KUBALEWSKI, JAMES STANLEY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:STANLEY
Last Name:KUBALEWSKI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 MASON COURT
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5472
Mailing Address - Country:US
Mailing Address - Phone:815-741-8462
Mailing Address - Fax:
Practice Address - Street 1:2212 MCDONOUGH ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60436-1842
Practice Address - Country:US
Practice Address - Phone:815-725-2209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490036501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical