Individual provider Active NPI

Thomas D Stuber, LPCC-SUPV

  • Clinical Social Worker
  • Lorain, OH
National Provider Identifier
1417360645
Registry record updated Jun 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
E.0001507-S Issued in OH
Practice address
2115 W Park Dr
Lorain, OH 44053
Phone
(440) 989-4900
Fax
(440) 282-4779
NPI assigned
Jun 5, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X
Clinical Social Worker 1041C0700X E.0001507-S OH Primary

Addresses

Primary practice location

2115 W Park Dr
Lorain, OH 44053

Mailing address

2115 W Park Dr
Lorain, OH 44053-1138
Phone (440) 989-4900

Other identifiers 1

IdentifierTypeStateIssuer
0162102MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
E.0001507-SOHMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1401926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528761600000",
    "number": "1417360645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2115 W PARK DR",
            "city": "LORAIN",
            "state": "OH",
            "postal_code": "440531138",
            "telephone_number": "440-989-4900",
            "fax_number": "440-282-4779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2115 W PARK DR",
            "city": "LORAIN",
            "state": "OH",
            "postal_code": "44053",
            "telephone_number": "440-989-4900",
            "fax_number": "440-282-4779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUBER",
        "first_name": "THOMAS",
        "middle_name": "D",
        "credential": "LPCC-SUPV",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-05",
        "last_updated": "2018-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "E.0001507-S",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0162102",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lorain, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.