Provider Demographics
NPI:1295156834
Name:KUPFERBERG, MITCHELL (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:
Last Name:KUPFERBERG
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 N PINE AVE
Mailing Address - Street 2:#3E
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-6168
Mailing Address - Country:US
Mailing Address - Phone:773-984-9672
Mailing Address - Fax:
Practice Address - Street 1:1845 E RAND RD
Practice Address - Street 2:STE. 106
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4356
Practice Address - Country:US
Practice Address - Phone:773-984-9672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-29
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.018685101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health