Provider Demographics
NPI:1821769571
Name:KUBAS, ANDREA (LAC, MA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:KUBAS
Suffix:
Gender:F
Credentials:LAC, MA
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 382
Mailing Address - Street 2:
Mailing Address - City:ALLENWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08720-0382
Mailing Address - Country:US
Mailing Address - Phone:732-245-9741
Mailing Address - Fax:
Practice Address - Street 1:2006 HIGHWAY 71 STE 4
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07762-2283
Practice Address - Country:US
Practice Address - Phone:732-245-9741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00407200103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty