Provider Demographics
NPI:1700997137
Name:KUBIAK, LARRY CURTIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:CURTIS
Last Name:KUBIAK
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 1:5398 PEMBRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-6800
Mailing Address - Country:US
Mailing Address - Phone:850-668-9763
Mailing Address - Fax:850-431-7478
Practice Address - Street 1:1616 PHYSICIANS DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4619
Practice Address - Country:US
Practice Address - Phone:850-431-5879
Practice Address - Fax:850-431-7478
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004011103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist