Provider Demographics
NPI:1114349073
Name:LUPO, ROSALIA JACQUELINE (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:ROSALIA
Middle Name:JACQUELINE
Last Name:LUPO
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 1:24 SHERMAN RD
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-3228
Mailing Address - Country:US
Mailing Address - Phone:516-637-2169
Mailing Address - Fax:
Practice Address - Street 1:24 SHERMAN RD
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-3228
Practice Address - Country:US
Practice Address - Phone:516-637-2169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-13
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0909371104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker