Healthcare Provider Details

I. General information

NPI: 1962553297
Provider Name (Legal Business Name): JEFFREY KUPFERMAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 W BROADWAY
HEWLETT NY
11557-1929
US

IV. Provider business mailing address

611 E BEECH ST
LONG BEACH NY
11561-3703
US

V. Phone/Fax

Practice location:
  • Phone: 516-314-4634
  • Fax:
Mailing address:
  • Phone: 516-432-6909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR019507-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: