Basic Information
| Provider Information | |||||||||
| NPI: | 1447594882 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LARISA KOUPERSCHMIDT MD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 246 WALNUT ST STE 104 | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024601639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172443322 | ||||||||
| FaxNumber: | 6175816040 | ||||||||
| Practice Location | |||||||||
| Address1: | 275 TURNPIKE ST STE 105 | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020212353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6179052697 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2012 | ||||||||
| LastUpdateDate: | 03/13/2013 | ||||||||
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| AuthorizedOfficialLastName: | KOUPERSCHMIDT | ||||||||
| AuthorizedOfficialFirstName: | LARISA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6179052697 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 246627 | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.