Provider Demographics
NPI:1487298428
Name:KUPRIAN, NADEZHDA (PHD)
Entity type:Individual
Prefix:
First Name:NADEZHDA
Middle Name:
Last Name:KUPRIAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:NADIA
Other - Middle Name:
Other - Last Name:KUPRIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1409 PACIFIC ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-3203
Mailing Address - Country:US
Mailing Address - Phone:646-509-0240
Mailing Address - Fax:
Practice Address - Street 1:225 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-3001
Practice Address - Country:US
Practice Address - Phone:646-509-0240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-02
Last Update Date:2019-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023501-01103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical