Provider Demographics
NPI:1073917191
Name:DZUBA, NOAH (MSW, ASW)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:
Last Name:DZUBA
Suffix:
Gender:M
Credentials:MSW, ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 S WASHINGTON SQ APT 1616
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4125
Mailing Address - Country:US
Mailing Address - Phone:267-536-5565
Mailing Address - Fax:
Practice Address - Street 1:604 S WASHINGTON SQ APT 1616
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4125
Practice Address - Country:US
Practice Address - Phone:267-536-5565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW63323104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker