Provider Demographics
NPI:1972980753
Name:JO-ELLEN HUBELBANK, LCSW, LLC
Entity Type:Organization
Organization Name:JO-ELLEN HUBELBANK, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JO-ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBELBANK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-288-0242
Mailing Address - Street 1:114 S MAIN ST
Mailing Address - Street 2:SUITE 28
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3111
Mailing Address - Country:US
Mailing Address - Phone:203-288-0242
Mailing Address - Fax:
Practice Address - Street 1:114 S MAIN ST
Practice Address - Street 2:SUITE 28
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3111
Practice Address - Country:US
Practice Address - Phone:203-288-0242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2023-08-23
Deactivation Date:2023-07-19
Deactivation Code:
Reactivation Date:2023-08-23
Provider Licenses
StateLicense IDTaxonomies
CT0041931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008058177Medicaid