Provider Demographics
NPI:1710089149
Name:JUBY, HEATHER (PHD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:JUBY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 FORT SALONGA RD
Mailing Address - Street 2:SUITE 10 #227
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2270
Mailing Address - Country:US
Mailing Address - Phone:609-937-0375
Mailing Address - Fax:
Practice Address - Street 1:1019 FORT SALONGA RD
Practice Address - Street 2:SUITE 10 #227
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2270
Practice Address - Country:US
Practice Address - Phone:609-937-0375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling