Healthcare Provider Details

I. General information

NPI: 1891208898
Provider Name (Legal Business Name): ERICA CUPURO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2017
Last Update Date: 11/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E ALGONQUIN RD
DES PLAINES IL
60016-6251
US

IV. Provider business mailing address

556 S 4TH AVE
DES PLAINES IL
60016-3205
US

V. Phone/Fax

Practice location:
  • Phone: 847-768-5556
  • Fax: 847-768-5556
Mailing address:
  • Phone: 847-630-5508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: