Healthcare Provider Details

I. General information

NPI: 1821108267
Provider Name (Legal Business Name): DEAN ANDREW HUBER MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W MAIN ST
MARION IL
62959-1188
US

IV. Provider business mailing address

312 S CANTERBURY DR
CARBONDALE IL
62901-2131
US

V. Phone/Fax

Practice location:
  • Phone: 618-997-5331
  • Fax: 618-998-5671
Mailing address:
  • Phone: 618-529-4651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: