Provider Demographics
NPI:1063985166
Name:PUPI, KATARINA
Entity type:Individual
Prefix:MRS
First Name:KATARINA
Middle Name:
Last Name:PUPI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 DUDLEY ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-3319
Mailing Address - Country:US
Mailing Address - Phone:508-333-2383
Mailing Address - Fax:
Practice Address - Street 1:132 ROBBS HILL RD
Practice Address - Street 2:
Practice Address - City:LUNENBURG
Practice Address - State:MA
Practice Address - Zip Code:01462-2167
Practice Address - Country:US
Practice Address - Phone:774-270-1766
Practice Address - Fax:508-861-0206
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAUEM981203273OtherBLUE CROSS BLUE SHIELD