Provider Demographics
NPI:1902920762
Name:KUBIC KNIGHT, JENNIFER LYNN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNN
Last Name:KUBIC KNIGHT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:KUBIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:940 BELMONT ST
Mailing Address - Street 2:11 PCC
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301
Mailing Address - Country:US
Mailing Address - Phone:774-826-2078
Mailing Address - Fax:617-724-1800
Practice Address - Street 1:940 BELMONT ST
Practice Address - Street 2:11 PCC
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:774-826-2078
Practice Address - Fax:617-724-1800
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041C0700X
MAMALICSW1132391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical