Provider Demographics
NPI:1861505059
Name:KUPERSMITH, ARTHUR (PHD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:
Last Name:KUPERSMITH
Suffix:
Gender:M
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-3867
Mailing Address - Country:US
Mailing Address - Phone:765-662-9971
Mailing Address - Fax:765-651-6556
Practice Address - Street 1:101 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-3867
Practice Address - Country:US
Practice Address - Phone:765-662-9971
Practice Address - Fax:765-651-6556
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TH0100X, 103T00000X
INLIC20090165A103TC0700X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100123560AMedicaid
IN000000317611OtherANTHEM
IN4027OtherMPLAN
IN776095000OtherMAGELLAN
IN350868083OtherTRICARE
IN88367428OtherCIGNA
IN177120AOtherMEDICARE
IN66108OtherVALUE OPTIONS
INLIC34001263AOtherVALUE OPTIONS - GM CLIENTS