Provider Demographics
NPI:1760982599
Name:JUBENVILLE, CYNTHIA WOLF (LMSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:WOLF
Last Name:JUBENVILLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:GRACE
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1230 N VAN BRUGGEN ST
Mailing Address - Street 2:
Mailing Address - City:PLAINWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49080-1147
Mailing Address - Country:US
Mailing Address - Phone:269-685-9561
Mailing Address - Fax:
Practice Address - Street 1:3304 COOLEY CT
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-7430
Practice Address - Country:US
Practice Address - Phone:269-349-2266
Practice Address - Fax:269-349-0792
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010358071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical