Provider Demographics
NPI:1356421465
Name:KUBACKI, STEVEN R (PHD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:R
Last Name:KUBACKI
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 1:3418 NE 65TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-7341
Mailing Address - Country:US
Mailing Address - Phone:206-235-9393
Mailing Address - Fax:206-517-8123
Practice Address - Street 1:3418 NE 65TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-7341
Practice Address - Country:US
Practice Address - Phone:206-235-9393
Practice Address - Fax:206-517-8123
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2316103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical