Provider Demographics
NPI:1174709828
Name:KUBAT, LAURA M (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:M
Last Name:KUBAT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 SW 66TH TER
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-5131
Mailing Address - Country:US
Mailing Address - Phone:954-336-3512
Mailing Address - Fax:
Practice Address - Street 1:2699 STIRLING RD
Practice Address - Street 2:B-304
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6517
Practice Address - Country:US
Practice Address - Phone:954-336-3512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2011-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7747101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1196908OtherCAQH
FL003104400Medicaid
FLMH7747OtherMENTAL HEALTH LICENSURE