Provider Demographics
NPI:1457867772
Name:KUBIAK, EWELINA (MED, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:EWELINA
Middle Name:
Last Name:KUBIAK
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:MS
Other - First Name:EWELINA
Other - Middle Name:
Other - Last Name:SIEDLECKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED BCBA
Mailing Address - Street 1:10842 BERKSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5032
Mailing Address - Country:US
Mailing Address - Phone:201-988-3743
Mailing Address - Fax:
Practice Address - Street 1:10842 BERKSHIRE ST
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-5032
Practice Address - Country:US
Practice Address - Phone:201-988-3743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-22
Last Update Date:2021-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-17-28095103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst