Provider Demographics
NPI:1336759844
Name:CHUBA, JOY ELLEN (LCSW)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:ELLEN
Last Name:CHUBA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:ELLEN
Other - Last Name:FOSDICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 W NEPTUNE RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5003
Mailing Address - Country:US
Mailing Address - Phone:407-742-1548
Mailing Address - Fax:
Practice Address - Street 1:110 W NEPTUNE RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5003
Practice Address - Country:US
Practice Address - Phone:407-742-1548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL173291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical