Active NPI
Mary June Kubach, LCSW
- Clinical Social Worker
- Prestonsburg, KY
National Provider Identifier
1619059623
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 3017
- Practice address
- 104 S Front Ave
Prestonsburg, KY 41653-1614 - Phone
- (606) 886-8572
- Fax
- (606) 886-4433
- NPI assigned
- Oct 19, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 3017 | KY | Primary |
Addresses
Primary practice location
104 S Front Ave
Prestonsburg, KY 41653-1614
Mailing address
104 S Front Ave
Prestonsburg, KY 41653-1614
Phone (606) 886-8572
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000211005 | Other | KY | BCBS PROVIDER NUMBER |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3017 | KY | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Trover Center for Behavioral Health | Clinical | Past | Accepting new patients |
| Stability Counseling and Associates LLC | Clinical | Past | Accepting new patients |
| Baptist Health Deaconess Madisonville Inc | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Baptist Health Deaconess Madisonville Outpatient Pharmacy
- Community/Retail Pharmacy
- Madisonville, KY
- NPI 1225347719
-
- Mental Health Counselor
- Henderson, KY
- NPI 1689170938
Clinical
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464652800000",
"number": "1619059623",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 S FRONT AVE",
"city": "PRESTONSBURG",
"state": "KY",
"postal_code": "416531614",
"telephone_number": "606-886-8572",
"fax_number": "606-886-4433"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 S FRONT AVE",
"city": "PRESTONSBURG",
"state": "KY",
"postal_code": "416531614",
"telephone_number": "606-886-8572",
"fax_number": "606-886-4433"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUBACH",
"first_name": "MARY",
"middle_name": "JUNE",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-19",
"last_updated": "2016-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "KY",
"license": "3017",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER NUMBER",
"identifier": "000000211005",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Prestonsburg, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.