Healthcare Provider Details

I. General information

NPI: 1316339963
Provider Name (Legal Business Name): EMILY JUBECK MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 GRUBB RD STE 240
WILMINGTON DE
19810-4796
US

IV. Provider business mailing address

217 N ADAMS ST APT A
WEST CHESTER PA
19380-2701
US

V. Phone/Fax

Practice location:
  • Phone: 302-475-1880
  • Fax:
Mailing address:
  • Phone: 484-354-9795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC-011074
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: