Provider Demographics
NPI:1235427824
Name:CUPPLES, CARMEN RENEE' (LISW)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:RENEE'
Last Name:CUPPLES
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 COUNTY ROAD 78
Mailing Address - Street 2:
Mailing Address - City:MOUNT CORY
Mailing Address - State:OH
Mailing Address - Zip Code:45868-9609
Mailing Address - Country:US
Mailing Address - Phone:419-812-3412
Mailing Address - Fax:
Practice Address - Street 1:230 W SANDUSKY ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-3218
Practice Address - Country:US
Practice Address - Phone:419-423-7812
Practice Address - Fax:419-423-9877
Is Sole Proprietor?:No
Enumeration Date:2011-07-16
Last Update Date:2011-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.10003301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical