Healthcare Provider Details

I. General information

NPI: 1619570520
Provider Name (Legal Business Name): JAMES A KUPER PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2020
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 HIGHLAND AVE
SCARBOROUGH ME
04074-8662
US

IV. Provider business mailing address

127 HIGHLAND AVE
SCARBOROUGH ME
04074-8662
US

V. Phone/Fax

Practice location:
  • Phone: 734-417-1843
  • Fax:
Mailing address:
  • Phone: 734-417-1843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10926
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS2052
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: