MEDICARE: MR. MITCHELL KUPFERBERG MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	149.018685	IL

General Provider Information

NPI Number	:	1295156834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MITCHELL KUPFERBERG MSW, LCSW

Provider Business Mailing Address
First Line	:	302 N PINE AVE
Second Line	:	#3E
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-6168
Country	:	US
Telephone Number	:	773-984-9672
Fax Number	:

Provider Business Practice Location Address
First Line	:	1845 E RAND RD
Second Line	:	STE. 106
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-4356
Country	:	US
Telephone Number	:	773-984-9672
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2013
Last Update Date	:	09/08/2016

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