Provider Demographics
NPI:1740531474
Name:KUBICKI, SANDRA G (PSYD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:G
Last Name:KUBICKI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 N GLENVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-1008
Mailing Address - Country:US
Mailing Address - Phone:714-878-6020
Mailing Address - Fax:
Practice Address - Street 1:1817 N GLENVIEW AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-1008
Practice Address - Country:US
Practice Address - Phone:714-878-6020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19409103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist