Provider Demographics
NPI:1215335138
Name:STUPINSKI, ANGELA CLARE (LICSW)
Entity type:Individual
Prefix:
First Name:ANGELA CLARE
Middle Name:
Last Name:STUPINSKI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CONSTITUTION PLZ STE 140
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-2025
Mailing Address - Country:US
Mailing Address - Phone:857-408-3409
Mailing Address - Fax:
Practice Address - Street 1:ONE CONSTITUTION WHARF
Practice Address - Street 2:SUITE 140
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129
Practice Address - Country:US
Practice Address - Phone:617-643-9409
Practice Address - Fax:617-643-9715
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA122522104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker