Provider Demographics
NPI:1194366880
Name:KUPERMAN, KERRY I
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:I
Last Name:KUPERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6826 CHANCELLOR DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-7613
Mailing Address - Country:US
Mailing Address - Phone:714-773-2721
Mailing Address - Fax:
Practice Address - Street 1:800 RIVERWOOD CT
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2890
Practice Address - Country:US
Practice Address - Phone:713-364-4654
Practice Address - Fax:214-238-8066
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst