Provider Demographics
NPI:1053092742
Name:KUBERT, SOFIYA (BCBA)
Entity type:Individual
Prefix:
First Name:SOFIYA
Middle Name:
Last Name:KUBERT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:SOFIYA
Other - Middle Name:
Other - Last Name:KOZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18828 VISTA DEL CANON UNIT B
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-4507
Mailing Address - Country:US
Mailing Address - Phone:818-387-5152
Mailing Address - Fax:
Practice Address - Street 1:18828 VISTA DEL CANON UNIT B
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-4507
Practice Address - Country:US
Practice Address - Phone:818-387-5152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-23-64556103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst