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NPI Code Detail

MEDICARE: MRS. CARMEN RENEE' CUPPLES LISW

MEDICARE: MRS. CARMEN RENEE' CUPPLES LISW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerI.1000330OH

General Provider Information

NPI Number : 1235427824
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CARMEN RENEE' CUPPLES LISW
Provider Business Mailing Address
First Line : 567 COUNTY ROAD 78
Second Line :
City : MOUNT CORY
State : OH
Zip : 45868-9609
Country : US
Telephone Number : 419-812-3412
Fax Number :
Provider Business Practice Location Address
First Line : 230 W SANDUSKY ST
Second Line :
City : FINDLAY
State : OH
Zip : 45840-3218
Country : US
Telephone Number : 419-423-7812
Fax Number : 419-423-9877
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2011
Last Update Date : 07/16/2011

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