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Organization
SOUTH TOWNS WELLNESS LCSW PLLC
Active
Organization
SOUTH TOWNS WELLNESS LCSW PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN KUBERA LCSW-R (MEMBER)
(716) 325-0006
Entity
Organization
Contact information
Practice address
162 MAIN ST, HAMBURG, NY 14075-4917
(716) 325-0006
Mailing address
188 LONG AVE, HAMBURG, NY 14075-6211
(716) 220-4224
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04126945
—
NY
Enumeration date
05/07/2015
Last updated
05/07/2021
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