Provider Demographics
NPI:1003957283
Name:DUPONT, NORMAN CHARLES (PHD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:CHARLES
Last Name:DUPONT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 JANET DRIVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-7424
Mailing Address - Country:US
Mailing Address - Phone:401-738-1945
Mailing Address - Fax:
Practice Address - Street 1:26 JANET DRIVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-7424
Practice Address - Country:US
Practice Address - Phone:401-738-1945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00200103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9009190Medicaid
6118900OtherUNITED HEALTH CARE
91905OtherBLUE CROSS
1022930OtherBEACON
330382OtherHARVARD PILGRIM