Provider Demographics
NPI:1558621276
Name:JUBA, CHERYL ANNE (MA)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:ANNE
Last Name:JUBA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-3109
Mailing Address - Country:US
Mailing Address - Phone:978-265-5881
Mailing Address - Fax:
Practice Address - Street 1:166 N MAIN ST
Practice Address - Street 2:SUITE 8
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-6504
Practice Address - Country:US
Practice Address - Phone:978-265-5881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3940101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health