Provider Demographics
NPI:1760775571
Name:WUBBENHORST, ROBERT FREDERICK (LCMHC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:FREDERICK
Last Name:WUBBENHORST
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 FLAMSTEAD RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05143-8893
Mailing Address - Country:US
Mailing Address - Phone:802-428-2008
Mailing Address - Fax:
Practice Address - Street 1:246 FLAMSTEAD RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VT
Practice Address - Zip Code:05143-8893
Practice Address - Country:US
Practice Address - Phone:802-428-2008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0072017101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health