Provider Demographics
NPI:1679549844
Name:KUBISZEWSKI, STEPHEN PETER (LMHC, MAC, CEAP)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:PETER
Last Name:KUBISZEWSKI
Suffix:
Gender:M
Credentials:LMHC, MAC, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE BROADWAY S.
Mailing Address - Street 2:C-307
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4121
Mailing Address - Country:US
Mailing Address - Phone:253-383-2588
Mailing Address - Fax:
Practice Address - Street 1:1 BROADWAY
Practice Address - Street 2:C 307
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4117
Practice Address - Country:US
Practice Address - Phone:253-383-2588
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00003902101YA0400X
WALH00006769101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional