MEDICARE: NUPTUALL LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1669209847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUPTUALL LLC

Provider Business Mailing Address
First Line	:	1175 MARLKRESS RD UNIT 3532
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08034-8069
Country	:	US
Telephone Number	:	856-544-2083
Fax Number	:

Provider Business Practice Location Address
First Line	:	1175 MARLKRESS RD UNIT 3532
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08034-8069
Country	:	US
Telephone Number	:	856-544-2083
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JUAN FLORES
Credential	:	LCSW, LCADC
Telephone Number	:	856-544-2083

Provider Enumeration Date	:	09/19/2024
Last Update Date	:	09/19/2024

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Directions to “NUPTUALL LLC ” Practice Location

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