Provider Demographics
NPI:1386834083
Name:DUPERVAL, MIRIELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRIELLE
Middle Name:
Last Name:DUPERVAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:MIRIELLE
Other - Middle Name:
Other - Last Name:DUPERVAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:391 LINDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2823
Mailing Address - Country:US
Mailing Address - Phone:718-282-1745
Mailing Address - Fax:
Practice Address - Street 1:391 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2823
Practice Address - Country:US
Practice Address - Phone:718-282-1745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-28
Last Update Date:2007-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1973132084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry