Healthcare Provider Details

I. General information

NPI: 1235427824
Provider Name (Legal Business Name): CARMEN RENEE' CUPPLES LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2011
Last Update Date: 07/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W SANDUSKY ST
FINDLAY OH
45840-3218
US

IV. Provider business mailing address

567 COUNTY ROAD 78
MOUNT CORY OH
45868-9609
US

V. Phone/Fax

Practice location:
  • Phone: 419-423-7812
  • Fax: 419-423-9877
Mailing address:
  • Phone: 419-812-3412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1000330
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: