Provider Demographics
NPI:1477657757
Name:KUBIC, NANCY LYNN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:LYNN
Last Name:KUBIC
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-1351
Mailing Address - Country:US
Mailing Address - Phone:401-816-5800
Mailing Address - Fax:401-816-5802
Practice Address - Street 1:625 MAIN RD
Practice Address - Street 2:
Practice Address - City:TIVERTON
Practice Address - State:RI
Practice Address - Zip Code:02878-1351
Practice Address - Country:US
Practice Address - Phone:401-816-5800
Practice Address - Fax:401-816-5802
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI1SW01673104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker