Healthcare Provider Details

I. General information

NPI: 1033468608
Provider Name (Legal Business Name): PRUDENCE FRANCES CUPER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5007 SOUTHPARK DR SUITE 250
DURHAM NC
27713-7739
US

IV. Provider business mailing address

5007 SOUTHPARK DR SUITE 250
DURHAM NC
27713-7739
US

V. Phone/Fax

Practice location:
  • Phone: 919-402-7987
  • Fax:
Mailing address:
  • Phone: 919-402-7987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number102971
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: