Provider Demographics
NPI:1790050383
Name:HUBBELL, MARY MARGARET (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:HUBBELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:MARGARET
Other - Last Name:BOUGHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2130 WILMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-8525
Mailing Address - Country:US
Mailing Address - Phone:317-590-1771
Mailing Address - Fax:
Practice Address - Street 1:2130 WILMINGTON BLVD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-8525
Practice Address - Country:US
Practice Address - Phone:317-590-1771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-14
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004813A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical