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Organization

THE CUBALA GROUP

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. KEVIN CUBALA PSYD (CLINICAL PSYCHOLOGIST)
(773) 882-0676
Entity
Organization

Contact information

Practice address
270 BROADMOOR LN, BARTLETT, IL 60103-4300
(773) 882-0676
(630) 524-9119
Mailing address
270 BROADMOOR LN, BARTLETT, IL 60103-4300
(773) 882-0676
(630) 524-9119

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071007681
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1225369804
MEDICARE NPI
IL
Enumeration date
08/04/2011
Last updated
08/04/2011
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