Provider Demographics
NPI:1225369804
Name:CUBALA, KEVIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:CUBALA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 ALGONQUIN RD STE 450
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-3108
Mailing Address - Country:US
Mailing Address - Phone:312-278-1166
Mailing Address - Fax:
Practice Address - Street 1:3601 ALGONQUIN RD STE 450
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-3108
Practice Address - Country:US
Practice Address - Phone:312-278-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007681103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical