Healthcare Provider Details

I. General information

NPI: 1962803197
Provider Name (Legal Business Name): LAURA KUPPERMAN-CARON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MICHIGAN AVE STE 901
CHICAGO IL
60602-3767
US

IV. Provider business mailing address

30 N MICHIGAN AVE STE 901
CHICAGO IL
60602-3767
US

V. Phone/Fax

Practice location:
  • Phone: 312-380-9155
  • Fax:
Mailing address:
  • Phone: 312-380-9155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 9118
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.010882
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: