Healthcare Provider Details

I. General information

NPI: 1396765657
Provider Name (Legal Business Name): MURRAY KUPERMINC PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2446 ALBANY AVE
WEST HARTFORD CT
06117-2598
US

IV. Provider business mailing address

2446 ALBANY AVE
WEST HARTFORD CT
06117-2598
US

V. Phone/Fax

Practice location:
  • Phone: 860-233-0222
  • Fax: 860-233-7716
Mailing address:
  • Phone: 860-233-0222
  • Fax: 860-233-7716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1130
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: