Provider Demographics
NPI:1104186238
Name:DUPUY, ANGELA MARIE
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:MARIE
Last Name:DUPUY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:DUPUY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:06/17/1963
Mailing Address - Street 1:2121 N.JONES 247#
Mailing Address - Street 2:247#
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108
Mailing Address - Country:US
Mailing Address - Phone:702-353-8128
Mailing Address - Fax:
Practice Address - Street 1:2121 N JONES BLVD
Practice Address - Street 2:247#
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-3300
Practice Address - Country:US
Practice Address - Phone:702-353-8128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst