Provider Demographics
NPI:1326314683
Name:LUPES, BOGDANA (LCSW)
Entity Type:Individual
Prefix:
First Name:BOGDANA
Middle Name:
Last Name:LUPES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8268 164TH ST # T5-A
Mailing Address - Street 2:QUEENS HOSPITAL CENTER/ACT 2 PROGRAM
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1121
Mailing Address - Country:US
Mailing Address - Phone:718-883-6517
Mailing Address - Fax:
Practice Address - Street 1:8268 164TH ST # T5-A
Practice Address - Street 2:QUEENS HOSPITAL CENTER/ACT 2 PROGRAM
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1121
Practice Address - Country:US
Practice Address - Phone:718-883-6517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079352-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical