Provider Demographics
NPI:1235364936
Name:TUBRE, STEPHEN L (LCSW)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:L
Last Name:TUBRE
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 1:4734 BANCROFT DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-1210
Mailing Address - Country:US
Mailing Address - Phone:504-858-9431
Mailing Address - Fax:504-284-6105
Practice Address - Street 1:4734 BANCROFT DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-1210
Practice Address - Country:US
Practice Address - Phone:504-858-9431
Practice Address - Fax:504-284-6105
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-25
Last Update Date:2009-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA20771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical