Provider Demographics
NPI:1679377709
Name:HUBBARD, KYLE E
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:E
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25701 N LAKELAND BLVD
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-2450
Mailing Address - Country:US
Mailing Address - Phone:216-396-8190
Mailing Address - Fax:
Practice Address - Street 1:25701 N LAKELAND BLVD
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-2450
Practice Address - Country:US
Practice Address - Phone:216-396-8190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty