Provider Demographics
NPI:1487025193
Name:KUPERSHTOKH, JENNY (LMSW)
Entity Type:Individual
Prefix:MS
First Name:JENNY
Middle Name:
Last Name:KUPERSHTOKH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 GRAVESEND NECK RD APT 2D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5568
Mailing Address - Country:US
Mailing Address - Phone:646-945-2081
Mailing Address - Fax:
Practice Address - Street 1:815 GRAVESEND NECK RD APT 2D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5568
Practice Address - Country:US
Practice Address - Phone:646-945-2081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY096384104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker