Healthcare Provider Details

I. General information

NPI: 1528583473
Provider Name (Legal Business Name): LARISA KUPRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 08/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 E 17TH ST FL 2
NEW YORK NY
10003-1949
US

IV. Provider business mailing address

5 E 17TH ST
NEW YORK NY
10003-1949
US

V. Phone/Fax

Practice location:
  • Phone: 212-989-2990
  • Fax: 212-792-6058
Mailing address:
  • Phone: 212-989-2990
  • Fax: 212-792-6058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: