Provider Demographics
NPI:1629602735
Name:CUBIT, GWENDOLYN (LMSW)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:CUBIT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:GWENDOLYN
Other - Middle Name:
Other - Last Name:CUBIT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:304 MILTON CV
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-2919
Mailing Address - Country:US
Mailing Address - Phone:512-350-6319
Mailing Address - Fax:
Practice Address - Street 1:1006 E YAGER LN STE 104A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-7039
Practice Address - Country:US
Practice Address - Phone:512-385-4799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60660104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker