Provider Demographics
NPI:1831240837
Name:BUBALA, JOSEPH ANTHONY (LCSW, LISAC)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:BUBALA
Suffix:
Gender:M
Credentials:LCSW, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18201
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85731-8201
Mailing Address - Country:US
Mailing Address - Phone:520-256-2737
Mailing Address - Fax:
Practice Address - Street 1:8747 E. GOLF LINKS
Practice Address - Street 2:RENEWAL HEALTH CENTER, LLC
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85730
Practice Address - Country:US
Practice Address - Phone:520-256-2737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW 06111041C0700X
AZLISAC 10291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical