Provider Demographics
NPI:1194931485
Name:CUPAC, SHERRY A (LCSW)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:A
Last Name:CUPAC
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 HERNDON PKWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-5286
Mailing Address - Country:US
Mailing Address - Phone:703-856-5595
Mailing Address - Fax:
Practice Address - Street 1:560 HERNDON PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5286
Practice Address - Country:US
Practice Address - Phone:703-856-5595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040044361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical