=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629602735
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GWENDOLYN CUBIT LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2020
-----------------------------------------------------
Last Update Date | 11/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1006 E YAGER LN STE 104A
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78753-7039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-385-4799
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 304 MILTON CV
-----------------------------------------------------
City | PFLUGERVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78660-2919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-350-6319
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 60660
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------