Healthcare Provider Details

I. General information

NPI: 1972537546
Provider Name (Legal Business Name): LEONARD WILLIAM KUPEC MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 TOWER AVENUE SUITE 301
HARTFORD CT
06112
US

IV. Provider business mailing address

675 TOWER AVENUE SUITE 301
HARTFORD CT
06112
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-2750
  • Fax: 860-714-8591
Mailing address:
  • Phone: 860-714-2750
  • Fax: 860-714-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number002543
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: