Provider Demographics
NPI:1497034706
Name:THE CUBALA GROUP
Entity Type:Organization
Organization Name:THE CUBALA GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUBALA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-882-0676
Mailing Address - Street 1:270 BROADMOOR LN
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-4300
Mailing Address - Country:US
Mailing Address - Phone:773-882-0676
Mailing Address - Fax:630-524-9119
Practice Address - Street 1:270 BROADMOOR LN
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-4300
Practice Address - Country:US
Practice Address - Phone:773-882-0676
Practice Address - Fax:630-524-9119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007681103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1225369804OtherMEDICARE NPI