Healthcare Provider Details

I. General information

NPI: 1700398419
Provider Name (Legal Business Name): KATHERINE KUPRENAS PMHNP-BC; LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2017
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 W 139TH ST
NEW YORK NY
10037-1508
US

IV. Provider business mailing address

34 W 139TH ST
NEW YORK NY
10037-1508
US

V. Phone/Fax

Practice location:
  • Phone: 212-690-7234
  • Fax:
Mailing address:
  • Phone: 212-690-7234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number405217
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number091455
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: