MEDICARE: CHRISTINE HUBBARD LCSW, LCADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	44SC05708900	NJ
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	37LC00233300	NJ

General Provider Information

NPI Number	:	1023527389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE HUBBARD LCSW, LCADC

Provider Business Mailing Address
First Line	:	80 VALLEY RD APT 2
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-2209
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 VALLEY RD APT 2
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-2209
Country	:	US
Telephone Number	:	201-562-9162
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2017
Last Update Date	:	09/29/2017

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