Provider Demographics
NPI:1134314370
Name:KUPIEC, SHARON SLOAT (ICADC)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:SLOAT
Last Name:KUPIEC
Suffix:
Gender:F
Credentials:ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 LONG HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-5063
Mailing Address - Country:US
Mailing Address - Phone:860-346-6489
Mailing Address - Fax:
Practice Address - Street 1:870 LONG HILL RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-5063
Practice Address - Country:US
Practice Address - Phone:860-346-6489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT23835101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCTGA000525OtherDMHAS
CTB000698OtherDMHAS