Basic Information
| Provider Information | |||||||||
| NPI: | 1861505059 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUPERSMITH | ||||||||
| FirstName: | ARTHUR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD., HSPP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 S WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469523867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7656629971 | ||||||||
| FaxNumber: | 7656516556 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 S WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469523867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7656629971 | ||||||||
| FaxNumber: | 7656516556 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 01/28/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TH0100X | N | Behavioral Health & Social Service Providers | Psychologist | Health Service | 103T00000X | N | Behavioral Health & Social Service Providers | Psychologist | 103TC0700X | LIC20090165A | IN | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC1900X | LIC20090165A | IN | N | Behavioral Health & Social Service Providers | Psychologist | Counseling |
ID Information
| ID | Type | State | Issuer | Description | 100123560A | 05 | IN | MEDICAID | 000000317611 | 01 | IN | ANTHEM | OTHER | 4027 | 01 | IN | MPLAN | OTHER | 776095000 | 01 | IN | MAGELLAN | OTHER | 350868083 | 01 | IN | TRICARE | OTHER | 88367428 | 01 | IN | CIGNA | OTHER | 177120A | 01 | IN | MEDICARE | OTHER | 66108 | 01 | IN | VALUE OPTIONS | OTHER | LIC34001263A | 01 | IN | VALUE OPTIONS - GM CLIENTS | OTHER |