Healthcare Provider Details

I. General information

NPI: 1730401241
Provider Name (Legal Business Name): ALICIA J KUPCHIK LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 PLEASANT ST
CONCORD NH
03301-4006
US

IV. Provider business mailing address

PO BOX 2032
CONCORD NH
03302-2032
US

V. Phone/Fax

Practice location:
  • Phone: 603-225-0123
  • Fax:
Mailing address:
  • Phone: 603-226-7505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1603
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: