Healthcare Provider Details

I. General information

NPI: 1356052773
Provider Name (Legal Business Name): JUSTIN JOHN HUPALO AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 LISA LN
PLEASANT HILL CA
94523-3993
US

IV. Provider business mailing address

1108 FOUNTAIN ST
ALAMEDA CA
94501-5548
US

V. Phone/Fax

Practice location:
  • Phone: 510-846-1850
  • Fax:
Mailing address:
  • Phone: 510-388-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number125867
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: