Provider Demographics
NPI:1366460222
Name:LUIPPOLD, STEPHEN A (RNCS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:LUIPPOLD
Suffix:
Gender:M
Credentials:RNCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 KING ST
Mailing Address - Street 2:
Mailing Address - City:HATFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01038-9774
Mailing Address - Country:US
Mailing Address - Phone:617-733-7407
Mailing Address - Fax:
Practice Address - Street 1:17 KING ST # S2676
Practice Address - Street 2:
Practice Address - City:HATFIELD
Practice Address - State:MA
Practice Address - Zip Code:01038-9774
Practice Address - Country:US
Practice Address - Phone:617-733-7407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230124163WP0808X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P06222Medicare UPIN
NS0Medicare PIN
NS0378Medicare PIN
NS0378Medicare ID - Type Unspecified