Provider Demographics
NPI:1891208898
Name:CUPURO, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:CUPURO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-3205
Mailing Address - Country:US
Mailing Address - Phone:847-630-5508
Mailing Address - Fax:
Practice Address - Street 1:777 E ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-6251
Practice Address - Country:US
Practice Address - Phone:847-768-5556
Practice Address - Fax:847-768-5556
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1194859975OtherSCHOOL DISTRICT