Healthcare Provider Details

I. General information

NPI: 1710055710
Provider Name (Legal Business Name): CARRIE ANN KUPIEC MSW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15A BOLTON PLACE
BROCKTON MA
02301-5316
US

IV. Provider business mailing address

520 JUNE STREET
FALL RIVER MA
02720-3546
US

V. Phone/Fax

Practice location:
  • Phone: 508-427-4383
  • Fax: 508-584-4328
Mailing address:
  • Phone: 508-678-4646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number214041
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: