Healthcare Provider Details

I. General information

NPI: 1447896352
Provider Name (Legal Business Name): STEPHANIE KUPER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2019
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 HARDING RD
FREEHOLD NJ
07728-5428
US

IV. Provider business mailing address

224 HARDING RD APT C
FREEHOLD NJ
07728-5428
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06512800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05904900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: