Provider Demographics
NPI:1154498368
Name:STORZBACH TUPPER, MARIA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:STORZBACH TUPPER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 ALDEN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-2109
Mailing Address - Country:US
Mailing Address - Phone:203-387-7474
Mailing Address - Fax:203-389-1838
Practice Address - Street 1:165 ALDEN AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-2109
Practice Address - Country:US
Practice Address - Phone:203-387-7474
Practice Address - Fax:203-389-1838
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0004681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT140000468CT01OtherANTHEM BC BS
CT800000177Medicare ID - Type UnspecifiedMEDICARE ID #