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General NPI Number Information
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NPI Number | 1316298755
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Entity Type | Organization
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Legal Business Name | DR. MICHAEL V. CUBIE,PH.D.
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Dates
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Enumeration Date | 09/25/2012
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Last Update Date | 09/25/2012
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Provider Practice Location Address
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Address Line | 35 E 10TH ST SUITE E3
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City | TRACY
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State | CA
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Zip | 95376-4058
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Country | US
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Telephone | 510-258-1163
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Fax | 209-830-1156
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Provider Business Mailing Address
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Address Line | PO BOX 306
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City | TRACY
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State | CA
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Zip | 95378-0306
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Country | US
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Telephone | 510-258-1163
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Fax | 209-830-1156
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. MICHAEL V. CUBIE
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Credential | PH.D.
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Telephone | 510-258-1163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | PSY20021
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License Number State | CA
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