Healthcare Provider Details

I. General information

NPI: 1275438756
Provider Name (Legal Business Name): ANDREA LUPPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2026
Last Update Date: 10/13/2026
Certification Date: 10/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 BROWNS LAKE RD
JACKSON MI
49201-8379
US

IV. Provider business mailing address

11607 HARRINGTON PL
BROOKLYN MI
49230-9437
US

V. Phone/Fax

Practice location:
  • Phone: 517-768-5214
  • Fax:
Mailing address:
  • Phone: 517-247-1971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801086087
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801086087
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: