MEDICARE: TINA HUBBARD LCSW-R

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	73076282	NY

General Provider Information

NPI Number	:	1306099213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA HUBBARD LCSW-R

Provider Business Mailing Address
First Line	:	275 PARRISH ST
Second Line	:	STE A
City	:	CANANDAIGUA
State	:	NY
Zip	:	14424-1785
Country	:	US
Telephone Number	:	585-412-9187
Fax Number	:	585-310-8514

Provider Business Practice Location Address
First Line	:	275 PARRISH ST
Second Line	:	STE A
City	:	CANANDAIGUA
State	:	NY
Zip	:	14424-1785
Country	:	US
Telephone Number	:	585-412-9187
Fax Number	:	585-310-8514

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

Provider Enumeration Date	:	10/23/2008
Last Update Date	:	11/17/2017

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