Healthcare Provider Details

I. General information

NPI: 1235755505
Provider Name (Legal Business Name): JONATHAN SCHUBERT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 LINCOLN ST STE 203
FRAMINGHAM MA
01702-8264
US

IV. Provider business mailing address

375 LINWOOD AVE
NEWTON MA
02460-1342
US

V. Phone/Fax

Practice location:
  • Phone: 508-500-6166
  • Fax: 508-500-6167
Mailing address:
  • Phone: 713-471-7377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number224820
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: