Provider Demographics
NPI:1568730497
Name:RUPERTO, AMELIA (CASAC-T)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:RUPERTO
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3535 ROCHAMBEAU AVE
Mailing Address - Street 2:APARTMENT 3G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-1311
Mailing Address - Country:US
Mailing Address - Phone:718-993-3397
Mailing Address - Fax:718-993-2460
Practice Address - Street 1:3535 ROCHAMBEAU AVE
Practice Address - Street 2:APARTMENT 3G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-1311
Practice Address - Country:US
Practice Address - Phone:718-993-3397
Practice Address - Fax:718-993-2460
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)