Healthcare Provider Details

I. General information

NPI: 1023942760
Provider Name (Legal Business Name): JENNA KUPFERSCHMID
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 E 147TH ST FL 5
BRONX NY
10455-4104
US

IV. Provider business mailing address

424 E 147TH ST FL 5
BRONX NY
10455-4104
US

V. Phone/Fax

Practice location:
  • Phone: 347-584-4010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number131613
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: