MEDICARE: MS. JOAN UPOLE LMHC

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	003910-1	NY

General Provider Information

NPI Number	:	1881132934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOAN UPOLE LMHC

Provider Business Mailing Address
First Line	:	900 SOUTH AVE STE 300
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3428
Country	:	US
Telephone Number	:	718-577-2272
Fax Number	:	347-824-2242

Provider Business Practice Location Address
First Line	:	900 SOUTH AVE STE 300
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3428
Country	:	US
Telephone Number	:	718-577-2272
Fax Number	:	347-824-2242

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

Provider Enumeration Date	:	02/09/2017
Last Update Date	:	06/19/2019

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