Provider Demographics
NPI:1861008955
Name:KUPRES, DEBORAH DIANNE (LLMSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:DIANNE
Last Name:KUPRES
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11335 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8627
Mailing Address - Country:US
Mailing Address - Phone:616-396-0623
Mailing Address - Fax:
Practice Address - Street 1:11335 JAMES ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8627
Practice Address - Country:US
Practice Address - Phone:616-396-0623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011072971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical