Provider Demographics
NPI:1902054323
Name:NANCY LYNN LEVESQUE KUBIC
Entity Type:Organization
Organization Name:NANCY LYNN LEVESQUE KUBIC
Other - Org Name:PSYCHOLOGICAL WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICSW
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KUBIC
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:401-816-5800
Mailing Address - Street 1:625 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-1351
Mailing Address - Country:US
Mailing Address - Phone:401-816-5800
Mailing Address - Fax:
Practice Address - Street 1:625 MAIN RD
Practice Address - Street 2:
Practice Address - City:TIVERTON
Practice Address - State:RI
Practice Address - Zip Code:02878-1351
Practice Address - Country:US
Practice Address - Phone:401-816-5800
Practice Address - Fax:401-816-5802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1082610OtherBEACON HEALTH STRATEGIES
RI294863OtherRHODE ISLAND BLUE CROSS & BLUE SHIELD
TX7651763OtherAETNA
RINK68179OtherRHODE ISLAND MEDICAL ASSISTANCE