Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | MA | |
Y | 101YM0800X | Mental Health Counselor | MA | |
N | 103TC1900X | Counseling Psychologist | ||
N | 103TE1100X | Exercise & Sports Psychologist |
NPI | 1043563042 |
---|---|
Provider Name | Ms. Ellie Luperon |
First Address | Woodstock, CT 06281-3307 |
Second Address | Woodstock, CT 06281-3307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2012 |
Last Update Date | 08/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1043563042 | (05) | MA |