Provider Demographics
NPI:1497276190
Name:LUPACCHINO, AZRA (LPC)
Entity Type:Individual
Prefix:
First Name:AZRA
Middle Name:
Last Name:LUPACCHINO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AZRA
Other - Middle Name:
Other - Last Name:OMERBASIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2 WATERSIDE XING STE 401
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-1588
Mailing Address - Country:US
Mailing Address - Phone:860-731-5522
Mailing Address - Fax:860-731-5536
Practice Address - Street 1:7 LEDGEBROOK DR UNIT B
Practice Address - Street 2:
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1664
Practice Address - Country:US
Practice Address - Phone:860-456-0038
Practice Address - Fax:860-456-8765
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor