MEDICARE: MARIAH KUBA

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	106S00000X	Behavior Technician		GA

General Provider Information

NPI Number	:	1588451355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAH KUBA

Provider Business Mailing Address
First Line	:	350 FAIRWAY DR STE 101
Second Line	:
City	:	DEERFIELD BCH
State	:	FL
Zip	:	33441-1834
Country	:	US
Telephone Number	:	877-418-2978
Fax Number	:	866-500-2186

Provider Business Practice Location Address
First Line	:	127 N PARK TRL
Second Line	:
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-7373
Country	:	US
Telephone Number	:	951-988-4989
Fax Number	:

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

Provider Enumeration Date	:	04/23/2025
Last Update Date	:	12/05/2025

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Directions to “ MARIAH KUBA ” Practice Location

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