Provider Demographics
NPI:1306885223
Name:LUPOLI, TERRI (LICSW)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:LUPOLI
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 1:1086 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-2738
Mailing Address - Country:US
Mailing Address - Phone:401-783-0523
Mailing Address - Fax:401-842-0360
Practice Address - Street 1:1086 SMITH ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-2738
Practice Address - Country:US
Practice Address - Phone:401-783-0523
Practice Address - Fax:401-842-0360
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW01462104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPENDINGMedicare ID - Type Unspecified