Healthcare Provider Details

I. General information

NPI: 1568580959
Provider Name (Legal Business Name): JUDITH CAROLYN KUPPERSMITH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 IRVING PL G12F
NEW YORK NY
10003-9701
US

IV. Provider business mailing address

1 IRVING PL G12F
NEW YORK NY
10003-9701
US

V. Phone/Fax

Practice location:
  • Phone: 212-505-6806
  • Fax:
Mailing address:
  • Phone: 212-505-6806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number000622
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: