Provider Demographics
NPI:1831721281
Name:STUBER, EDWARD O (MA, ICAADC)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:O
Last Name:STUBER
Suffix:
Gender:M
Credentials:MA, ICAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6808 CLUBHOUSE DR APT G
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-7010
Mailing Address - Country:US
Mailing Address - Phone:717-461-2299
Mailing Address - Fax:
Practice Address - Street 1:6808 CLUBHOUSE DR APT G
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-7010
Practice Address - Country:US
Practice Address - Phone:717-461-2299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC015144101YP2500X
PA9210101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional