Provider Demographics
NPI:1629571542
Name:KUBAS, JESSICA LYNNE ROSE (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNNE ROSE
Last Name:KUBAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2615
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959
Mailing Address - Country:US
Mailing Address - Phone:530-402-5613
Mailing Address - Fax:
Practice Address - Street 1:103 PROVIDENCE MINE RD
Practice Address - Street 2:STE 104A
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2949
Practice Address - Country:US
Practice Address - Phone:530-402-5613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-16
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA805021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical