Provider Demographics
NPI:1922866987
Name:KUBENA, RICHARD JEFFREY JR (LPC-A)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JEFFREY
Last Name:KUBENA
Suffix:JR
Gender:M
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:CT
Mailing Address - Zip Code:06237-1315
Mailing Address - Country:US
Mailing Address - Phone:203-744-9360
Mailing Address - Fax:
Practice Address - Street 1:2 OLD NEW MILFORD RD STE 2A
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2426
Practice Address - Country:US
Practice Address - Phone:203-775-3820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6469101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional