Provider Demographics
NPI:1508684184
Name:LUPO, ANTHNONY VINCENT (MSW,LSW)
Entity type:Individual
Prefix:
First Name:ANTHNONY
Middle Name:VINCENT
Last Name:LUPO
Suffix:
Gender:M
Credentials:MSW,LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3158 SANTEE RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-2850
Mailing Address - Country:US
Mailing Address - Phone:484-544-9488
Mailing Address - Fax:
Practice Address - Street 1:539 CENTER ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5910
Practice Address - Country:US
Practice Address - Phone:484-896-9161
Practice Address - Fax:484-251-5150
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW140681101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health