Provider Demographics
NPI:1518715036
Name:CUBBISON, AMY (MA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:CUBBISON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7953 CALLE POSADA
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-9306
Mailing Address - Country:US
Mailing Address - Phone:760-688-2100
Mailing Address - Fax:
Practice Address - Street 1:7953 CALLE POSADA
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-9306
Practice Address - Country:US
Practice Address - Phone:760-688-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA146732106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist