Provider Demographics
NPI:1326563248
Name:JUBY, BETHANY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:
Last Name:JUBY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 N CASS AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-6401
Mailing Address - Country:US
Mailing Address - Phone:708-336-9285
Mailing Address - Fax:
Practice Address - Street 1:825 N CASS AVE STE 112
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559
Practice Address - Country:US
Practice Address - Phone:708-336-9285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4879103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical