MEDICARE: MICHAEL JAN KUBAT LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904005075	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184629164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JAN KUBAT LCSW

Provider Business Mailing Address
First Line	:	5205 CHIPPING LN
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6802
Country	:	US
Telephone Number	:	757-473-8656
Fax Number	:

Provider Business Practice Location Address
First Line	:	319 EDWIN DR
Second Line	:	STE 103
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4541
Country	:	US
Telephone Number	:	757-497-9545
Fax Number	:	757-497-8192

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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