Healthcare Provider Details

I. General information

NPI: 1295744142
Provider Name (Legal Business Name): JEFFREY H KUPFER PHD, PSYD, BCBA-D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 DRY CREEK DR STE 100-B
LONGMONT CO
80503-6409
US

IV. Provider business mailing address

1330 S POTOMAC ST STE 112
AURORA CO
80012-4527
US

V. Phone/Fax

Practice location:
  • Phone: 970-310-3406
  • Fax: 888-965-4615
Mailing address:
  • Phone: 720-845-6675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number7304
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number575
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-00-0058
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2277
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1-00-0058
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: