Provider Demographics
NPI:1699248625
Name:CZUP, THERESE CHIARA (PHD)
Entity type:Individual
Prefix:DR
First Name:THERESE
Middle Name:CHIARA
Last Name:CZUP
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 PIN OAK PL
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-3672
Mailing Address - Country:US
Mailing Address - Phone:440-666-7985
Mailing Address - Fax:
Practice Address - Street 1:10050 INNOVATION DR STE 320
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-4933
Practice Address - Country:US
Practice Address - Phone:440-666-7985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHKU1036633103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty