Provider Demographics
NPI:1972696151
Name:TUBACH, DOUGLAS STEPHEN (MA)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:STEPHEN
Last Name:TUBACH
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PLYMPTON ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-1602
Mailing Address - Country:US
Mailing Address - Phone:508-947-1901
Mailing Address - Fax:508-923-3462
Practice Address - Street 1:6 PLYMPTON ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-1602
Practice Address - Country:US
Practice Address - Phone:508-947-1901
Practice Address - Fax:508-923-3462
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5382101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health