Provider Demographics
NPI:1457372138
Name:JEFF KUPFER PA
Entity Type:Organization
Organization Name:JEFF KUPFER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:H
Authorized Official - Last Name:KUPFER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD BCBA
Authorized Official - Phone:303-899-4020
Mailing Address - Street 1:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-0085
Mailing Address - Country:US
Mailing Address - Phone:303-899-4020
Mailing Address - Fax:720-304-0028
Practice Address - Street 1:218 GARFIELD LN
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516
Practice Address - Country:US
Practice Address - Phone:303-899-4020
Practice Address - Fax:720-304-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66186854Medicaid
COC807423Medicare PIN