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General NPI Number Information
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NPI Number | 1922866987
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Entity Type | Individual
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Provider Name | RICHARD JEFFREY KUBENA JR. LPC-A
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Gender | Male
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Dates
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Enumeration Date | 03/13/2024
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Last Update Date | 03/13/2024
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Provider Practice Location Address
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Address Line | 2 OLD NEW MILFORD RD STE 2A
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City | BROOKFIELD
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State | CT
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Zip | 06804-2426
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Country | US
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Telephone | 203-775-3820
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Fax |
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Provider Business Mailing Address
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Address Line | 45 LAKE RD
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City | COLUMBIA
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State | CT
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Zip | 06237-1315
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Country | US
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Telephone | 203-744-9360
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6469
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License Number State | CT
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