Provider Demographics
NPI:1861580045
Name:RUPERT, PATRICIA A (LCSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:RUPERT
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 1:90 E 2ND ST
Mailing Address - Street 2:PO BOX 270
Mailing Address - City:EMPORIUM
Mailing Address - State:PA
Mailing Address - Zip Code:15834-1302
Mailing Address - Country:US
Mailing Address - Phone:814-486-1115
Mailing Address - Fax:814-486-0404
Practice Address - Street 1:90 E 2ND ST
Practice Address - Street 2:
Practice Address - City:EMPORIUM
Practice Address - State:PA
Practice Address - Zip Code:15834-1302
Practice Address - Country:US
Practice Address - Phone:814-486-1115
Practice Address - Fax:814-486-0404
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW007586L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
O36712Medicare UPIN
PA628497OtherBLUE CROSS BLUE SHIELD
NY00026802701OtherUNIVERA
276371OtherUBH
O36712Medicare UPIN
IP160705OtherMAGELLAN
IP160705OtherMAGELLAN