Healthcare Provider Details

I. General information

NPI: 1922396407
Provider Name (Legal Business Name): MR. NATHAN BAE KUPEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 CAMBRIDGE ST
CAMBRIDGE MA
02141-1204
US

IV. Provider business mailing address

52 PARK ST # 1
SOMERVILLE MA
02143-3614
US

V. Phone/Fax

Practice location:
  • Phone: 617-547-0909
  • Fax: 617-497-5952
Mailing address:
  • Phone: 207-329-4671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: