Provider Demographics
NPI:1861569840
Name:KUPERSMITH, GLENDA J (LISW)
Entity type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:J
Last Name:KUPERSMITH
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30800 GATES MILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:PEPPER PIKE
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4370
Mailing Address - Country:US
Mailing Address - Phone:440-442-1431
Mailing Address - Fax:
Practice Address - Street 1:34950 CHARDON RD
Practice Address - Street 2:STE. 202
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-9162
Practice Address - Country:US
Practice Address - Phone:440-510-5100
Practice Address - Fax:440-510-5151
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 00071081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical