Healthcare Provider Details

I. General information

NPI: 1487298428
Provider Name (Legal Business Name): NADEZHDA KUPRIAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NADIA KUPRIAN PH.D.

II. Dates (important events)

Enumeration Date: 11/02/2019
Last Update Date: 11/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 BROADWAY
NEW YORK NY
10007-3001
US

IV. Provider business mailing address

1409 PACIFIC ST APT 1
BROOKLYN NY
11216-3203
US

V. Phone/Fax

Practice location:
  • Phone: 646-509-0240
  • Fax:
Mailing address:
  • Phone: 646-509-0240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number023501-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: