Provider Demographics
NPI:1366287286
Name:KUPERSMITH, SYDNEY (LMSW)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:KUPERSMITH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 SAGAMORE DR
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1524
Mailing Address - Country:US
Mailing Address - Phone:516-404-5184
Mailing Address - Fax:
Practice Address - Street 1:39 W 14TH ST STE 506
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7403
Practice Address - Country:US
Practice Address - Phone:929-777-0173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123672104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker