Healthcare Provider Details

I. General information

NPI: 1609016112
Provider Name (Legal Business Name): LAURA JAYNE KUPERMAN-CORWIN MSW, LCSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 07/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 E MAIN ST
CHICOPEE MA
01020-3638
US

IV. Provider business mailing address

96 INVERNESS LN
LONGMEADOW MA
01106-2818
US

V. Phone/Fax

Practice location:
  • Phone: 413-592-5414
  • Fax:
Mailing address:
  • Phone: 413-567-6366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number004914
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number110426
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: