Provider Demographics
NPI:1447809843
Name:CUBBERLY, CHAD BRYNLY (LMSW)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:BRYNLY
Last Name:CUBBERLY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 W SQUARE LAKE RD STE 111
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0462
Mailing Address - Country:US
Mailing Address - Phone:248-452-5640
Mailing Address - Fax:248-452-5681
Practice Address - Street 1:7 W SQUARE LAKE RD STE 111
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0462
Practice Address - Country:US
Practice Address - Phone:248-452-4640
Practice Address - Fax:248-452-5681
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2024-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011176431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty