Healthcare Provider Details

I. General information

NPI: 1225570518
Provider Name (Legal Business Name): DANIELLE KUPPERMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 CRESCENT RD
LIVINGSTON NJ
07039-3757
US

IV. Provider business mailing address

47 CRESCENT RD
LIVINGSTON NJ
07039-3757
US

V. Phone/Fax

Practice location:
  • Phone: 973-994-1941
  • Fax:
Mailing address:
  • Phone: 973-994-1941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05047700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: