Provider Demographics
NPI:1356572051
Name:CHUPP, RONALD ALLEN (LCSW,NCAC-II, ICAC-I)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:ALLEN
Last Name:CHUPP
Suffix:
Gender:M
Credentials:LCSW,NCAC-II, ICAC-I
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2621 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-3880
Mailing Address - Country:US
Mailing Address - Phone:574-267-7169
Mailing Address - Fax:574-269-4189
Practice Address - Street 1:101 E PARK DR
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:IN
Practice Address - Zip Code:46701-1438
Practice Address - Country:US
Practice Address - Phone:260-636-6884
Practice Address - Fax:260-636-3992
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN34005760A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN581480UMedicare PIN