Provider Demographics
NPI:1760885107
Name:CZUBAK, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:CZUBAK
Suffix:
Gender:F
Credentials:
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 10
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-0010
Mailing Address - Country:US
Mailing Address - Phone:517-927-6595
Mailing Address - Fax:
Practice Address - Street 1:4660 S HAGADORN RD
Practice Address - Street 2:SUITE 280A
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5376
Practice Address - Country:US
Practice Address - Phone:517-927-6595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361004348103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist