Provider Demographics
NPI:1720136872
Name:PUPO, CARMEN JEAN (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:JEAN
Last Name:PUPO
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2659 GRANADA CIR E
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-3921
Mailing Address - Country:US
Mailing Address - Phone:727-867-7876
Mailing Address - Fax:
Practice Address - Street 1:2659 GRANADA CIR E
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-3921
Practice Address - Country:US
Practice Address - Phone:727-867-7876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4944101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL766509100Medicaid