Healthcare Provider Details

I. General information

NPI: 1366216152
Provider Name (Legal Business Name): MICHELLE MARIE CUPO MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 S MAIN ST STE 101
FLEMINGTON NJ
08822-1787
US

IV. Provider business mailing address

5 MESA CT
OXFORD NJ
07863-3237
US

V. Phone/Fax

Practice location:
  • Phone: 908-923-3969
  • Fax:
Mailing address:
  • Phone: 908-295-3865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06271500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: