Provider Demographics
NPI:1275503484
Name:ZUBENKO, ALEXANDER (LCPC)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:ZUBENKO
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4699 AUVERGNE AVE
Mailing Address - Street 2:SUITE #7
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1911
Mailing Address - Country:US
Mailing Address - Phone:630-960-5860
Mailing Address - Fax:630-960-5864
Practice Address - Street 1:4699 AUVERGNE AVE
Practice Address - Street 2:SUITE #7
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1911
Practice Address - Country:US
Practice Address - Phone:630-960-5860
Practice Address - Fax:630-960-5864
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02207933OtherBLUE CROSS/BLUE SHIELD