=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013794510
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALAN DUPONT PSCYHOTHERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2023
-----------------------------------------------------
Last Update Date | 09/11/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 49 BARDWELL ST APT 3
-----------------------------------------------------
City | SOUTH HADLEY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01075-2589
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-732-5447
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 49 BARDWELL ST APT 3
-----------------------------------------------------
City | SOUTH HADLEY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01075-2589
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-732-5447
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ALAN DUPONT
-----------------------------------------------------
Credential | LICSW
-----------------------------------------------------
Telephone | 585-732-5447
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------