Provider Demographics
NPI:1851747760
Name:KUPERSMITH, REBECCA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:KUPERSMITH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 MONTGOMERY ST
Mailing Address - Street 2:#A6
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-2864
Mailing Address - Country:US
Mailing Address - Phone:917-536-6161
Mailing Address - Fax:
Practice Address - Street 1:377 MONTGOMERY ST
Practice Address - Street 2:#A6
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-2864
Practice Address - Country:US
Practice Address - Phone:415-722-0125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025689235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist