Healthcare Provider Details

I. General information

NPI: 1639621899
Provider Name (Legal Business Name): ASHLEE DUPONT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 SOUTH UNION ST SUIT 116
METHUEN MA
01843
US

IV. Provider business mailing address

439 SOUTH UNION ST SUIT 116
METHUEN MA
01843
US

V. Phone/Fax

Practice location:
  • Phone: 978-682-9222
  • Fax:
Mailing address:
  • Phone: 978-682-9222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: