Provider Demographics
NPI:1164205571
Name:HUBBARD, ROSALYN (LMSW)
Entity Type:Individual
Prefix:
First Name:ROSALYN
Middle Name:
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 DEER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:EVERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:76140-4705
Mailing Address - Country:US
Mailing Address - Phone:817-703-5605
Mailing Address - Fax:
Practice Address - Street 1:501 DEER CREEK RD
Practice Address - Street 2:
Practice Address - City:EVERMAN
Practice Address - State:TX
Practice Address - Zip Code:76140-4705
Practice Address - Country:US
Practice Address - Phone:817-703-5605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110583104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker