Provider Demographics
NPI:1902016769
Name:RUPERT, CAROL ANNETTE (LCSW-R, CASAC-T)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANNETTE
Last Name:RUPERT
Suffix:
Gender:F
Credentials:LCSW-R, CASAC-T
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:RUPERT
Other - Last Name:BARTOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPH, MEDICARE PROVID
Mailing Address - Street 1:801 W END AVE
Mailing Address - Street 2:APARTMENT 5C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5368
Mailing Address - Country:US
Mailing Address - Phone:212-662-6486
Mailing Address - Fax:
Practice Address - Street 1:937 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-2347
Practice Address - Country:US
Practice Address - Phone:718-789-9726
Practice Address - Fax:718-789-4308
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR050847-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNR0341Medicare ID - Type UnspecifiedPROVIDER NUMBER