Provider Demographics
NPI:1184387151
Name:KUPSTIS, KYLE JOSEPH
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:JOSEPH
Last Name:KUPSTIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:CT
Mailing Address - Zip Code:06444-0056
Mailing Address - Country:US
Mailing Address - Phone:860-302-5082
Mailing Address - Fax:
Practice Address - Street 1:76 NASSAU ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-4835
Practice Address - Country:US
Practice Address - Phone:860-302-5082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician