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General NPI Number Information
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NPI Number | 1356052773
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Entity Type | Individual
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Provider Name | JUSTIN JOHN HUPALO AMFT
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Gender | Male
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Dates
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Enumeration Date | 12/06/2022
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Last Update Date | 12/06/2022
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Provider Practice Location Address
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Address Line | 2400 LISA LN
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City | PLEASANT HILL
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State | CA
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Zip | 94523-3993
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Country | US
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Telephone | 510-846-1850
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Fax |
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Provider Business Mailing Address
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Address Line | 1108 FOUNTAIN ST
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City | ALAMEDA
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State | CA
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Zip | 94501-5548
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Country | US
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Telephone | 510-388-4242
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 125867
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License Number State | CA
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