Provider Demographics
NPI:1972854016
Name:LUPKIN, MICHELLE ILENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ILENE
Last Name:LUPKIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ILENE
Other - Last Name:GITLITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:513 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2935
Mailing Address - Country:US
Mailing Address - Phone:917-570-7472
Mailing Address - Fax:
Practice Address - Street 1:513 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-2935
Practice Address - Country:US
Practice Address - Phone:917-570-7472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019630-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical