Healthcare Provider Details

I. General information

NPI: 1215932694
Provider Name (Legal Business Name): SHARON L. KUEBBING PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 N MARKET ST
FREDERICK MD
21701-5419
US

IV. Provider business mailing address

41 N MARKET ST
FREDERICK MD
21701-5419
US

V. Phone/Fax

Practice location:
  • Phone: 301-662-6226
  • Fax: 301-682-6040
Mailing address:
  • Phone: 301-662-6226
  • Fax: 301-682-6040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number01333
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: