Healthcare Provider Details

I. General information

NPI: 1033254495
Provider Name (Legal Business Name): JACQUELINE M DUPONT M.ED, LMHC, LSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 BERKSHIRE ST
INDIAN ORCHARD MA
01151-1406
US

IV. Provider business mailing address

90 BERKSHIRE ST
INDIAN ORCHARD MA
01151-1406
US

V. Phone/Fax

Practice location:
  • Phone: 413-787-7036
  • Fax:
Mailing address:
  • Phone: 413-787-7036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7211
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number447664
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: