Healthcare Provider Details

I. General information

NPI: 1619399052
Provider Name (Legal Business Name): KERRY HUBEL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2014
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 DI SALVO AVE STE 40
SAN JOSE CA
95128-1714
US

IV. Provider business mailing address

1010 FULTON AVE
SUNNYVALE CA
94089-1509
US

V. Phone/Fax

Practice location:
  • Phone: 408-462-0442
  • Fax: 408-549-2472
Mailing address:
  • Phone: 408-306-4139
  • Fax: 408-549-2472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY26160
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY26160
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: