MEDICARE: DUPERLY WRIGHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	IMF29562	CA
2	106H00000X	Marriage & Family Therapist	MFT46673	CA

General Provider Information

NPI Number	:	1295959096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUPERLY WRIGHT

Provider Business Mailing Address
First Line	:	4125 BLACKFORD AVE STE 245
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95117-1705
Country	:	US
Telephone Number	:	408-406-7698
Fax Number	:

Provider Business Practice Location Address
First Line	:	4125 BLACKFORD AVE STE 245
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95117-1705
Country	:	US
Telephone Number	:	408-406-7698
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	10/17/2023

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Directions to “ DUPERLY WRIGHT ” Practice Location

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