Provider Demographics
NPI:1093093502
Name:JUPINA, NICHOLAS ANTHONY (LCSW)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ANTHONY
Last Name:JUPINA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4328 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-9133
Mailing Address - Country:US
Mailing Address - Phone:610-867-5328
Mailing Address - Fax:610-821-2037
Practice Address - Street 1:1728 W JONATHAN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-3170
Practice Address - Country:US
Practice Address - Phone:610-360-1462
Practice Address - Fax:610-821-2037
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0125801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical