Individual
CARYN BUB-STANDAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, LMFT
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2792-123
WI
106H00000X
Marriage & Family Therapist
186-124
WI
106H00000X
Marriage & Family Therapist
471-124
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
391805443007
BCBS
WI
05
—
39645500
—
WI
Enumeration date
01/11/2007
Last updated
09/26/2022
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