Provider Demographics
NPI:1306099213
Name:HUBBARD, TINA (LCSW-R)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:MATEVISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:275 PARRISH ST
Mailing Address - Street 2:STE A
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1785
Mailing Address - Country:US
Mailing Address - Phone:585-412-9187
Mailing Address - Fax:585-310-8514
Practice Address - Street 1:275 PARRISH ST
Practice Address - Street 2:STE A
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1785
Practice Address - Country:US
Practice Address - Phone:585-412-9187
Practice Address - Fax:585-310-8514
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY730762821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical