Provider Demographics
NPI:1053425074
Name:GUBNER, KATHRINE F (LCSW)
Entity type:Individual
Prefix:
First Name:KATHRINE
Middle Name:F
Last Name:GUBNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CHAPEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:CT
Mailing Address - Zip Code:06784-2205
Mailing Address - Country:US
Mailing Address - Phone:203-247-4416
Mailing Address - Fax:203-857-0457
Practice Address - Street 1:1281 ROUTE 311 STE B104
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:NY
Practice Address - Zip Code:12563-2829
Practice Address - Country:US
Practice Address - Phone:203-247-4416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0041251041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004248599Medicaid
NY04269756Medicaid