Provider Demographics
NPI:1538430822
Name:BETH SHUBERT, PA
Entity type:Organization
Organization Name:BETH SHUBERT, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-373-7715
Mailing Address - Street 1:2630 NW 41ST ST STE A
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6666
Mailing Address - Country:US
Mailing Address - Phone:352-373-7715
Mailing Address - Fax:
Practice Address - Street 1:2630 NW 41ST ST STE A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6666
Practice Address - Country:US
Practice Address - Phone:352-373-7715
Practice Address - Fax:352-372-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW17501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty