MEDICARE: V&D PSYCHIATRY, LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	W57111661-01	HI

General Provider Information

NPI Number	:	1396173894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	V&D PSYCHIATRY, LLC

Provider Business Mailing Address
First Line	:	4725 BOUGAINVILLE DR
Second Line	:	#351
City	:	HONOLULU
State	:	HI
Zip	:	96818-3179
Country	:	US
Telephone Number	:	888-321-7760
Fax Number	:

Provider Business Practice Location Address
First Line	:	4725 BOUGAINVILLE DR
Second Line	:	#351
City	:	HONOLULU
State	:	HI
Zip	:	96818-3179
Country	:	US
Telephone Number	:	888-321-7760
Fax Number	:

Authorized Official
Title or Position	:	CEO/PROVIDER
Name	:	MR. ROBERT P DUPREY JR.
Credential	:	APRN-RX, PMHNP-BC
Telephone Number	:	888-321-7760

Provider Enumeration Date	:	10/17/2013
Last Update Date	:	10/17/2013

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