Provider Demographics
NPI:1356498810
Name:LUPEI, ROGER A (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:A
Last Name:LUPEI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 NORTH BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1169
Mailing Address - Country:US
Mailing Address - Phone:708-524-0307
Mailing Address - Fax:708-524-1467
Practice Address - Street 1:1024 NORTH BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1169
Practice Address - Country:US
Practice Address - Phone:708-524-0307
Practice Address - Fax:708-524-1467
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1672709OtherBLUE CROSS BLUE SHIELD
IL1672709OtherBLUE CROSS BLUE SHIELD