Provider Demographics
NPI:1508854480
Name:KUPIETZ, SAMUEL SAUL (PHD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:SAUL
Last Name:KUPIETZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 WEAVER ST
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-1301
Mailing Address - Country:US
Mailing Address - Phone:914-833-2949
Mailing Address - Fax:914-833-2949
Practice Address - Street 1:431 WEAVER ST
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-1301
Practice Address - Country:US
Practice Address - Phone:914-833-2949
Practice Address - Fax:914-833-2949
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4054103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00390941Medicaid
NY00390941Medicaid
NYR50587Medicare UPIN