Healthcare Provider Details

I. General information

NPI: 1457372138
Provider Name (Legal Business Name): JEFF KUPFER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 GARFIELD LN
ERIE CO
80516
US

IV. Provider business mailing address

PO BOX 85
ERIE CO
80516-0085
US

V. Phone/Fax

Practice location:
  • Phone: 303-899-4020
  • Fax: 720-304-0028
Mailing address:
  • Phone: 303-899-4020
  • Fax: 720-304-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY H KUPFER
Title or Position: PRESIDENT
Credential: PHD BCBA
Phone: 303-899-4020