Provider Demographics
NPI:1548308174
Name:CUBERO, WENDY LORAINE (EDS)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:LORAINE
Last Name:CUBERO
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-5009
Mailing Address - Country:US
Mailing Address - Phone:252-823-2927
Mailing Address - Fax:
Practice Address - Street 1:325 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-5009
Practice Address - Country:US
Practice Address - Phone:252-823-2927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4058101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102655Medicaid
NC2132311OtherCIGNA BEHAVIORAL HEALTH
NC6102655Medicaid