Provider Demographics
NPI:1093469876
Name:KUPERSHTEYN, YEVGENIYA (LMSW)
Entity Type:Individual
Prefix:
First Name:YEVGENIYA
Middle Name:
Last Name:KUPERSHTEYN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 90TH ST APT 6
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-5814
Mailing Address - Country:US
Mailing Address - Phone:718-908-6911
Mailing Address - Fax:
Practice Address - Street 1:225 BROADWAY STE 1605
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-3756
Practice Address - Country:US
Practice Address - Phone:212-693-4010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105374104100000X
NY0963671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker