Provider Demographics
NPI:1528091865
Name:LUPATKIN, DONNA FAITH (LICSW)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:FAITH
Last Name:LUPATKIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 HARVARD ST
Mailing Address - Street 2:SUITE 36
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5069
Mailing Address - Country:US
Mailing Address - Phone:781-942-6311
Mailing Address - Fax:617-232-4145
Practice Address - Street 1:233 HARVARD ST
Practice Address - Street 2:SUITE 36
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5069
Practice Address - Country:US
Practice Address - Phone:781-942-6311
Practice Address - Fax:617-232-4145
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1048111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LUPO2956OtherBLUE CROSS BLUE SHIELD