Provider Demographics
NPI:1881819324
Name:DUBRAVA, THOMAS JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:DUBRAVA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 AVON DRIVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-3301
Mailing Address - Country:US
Mailing Address - Phone:937-320-1903
Mailing Address - Fax:
Practice Address - Street 1:4301 STATE ROUTE 725
Practice Address - Street 2:SUITE B
Practice Address - City:BELLBROOK
Practice Address - State:OH
Practice Address - Zip Code:45305-1552
Practice Address - Country:US
Practice Address - Phone:937-848-9858
Practice Address - Fax:937-848-2080
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3493103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000257883OtherANTHEM BC AND BS