Provider Demographics
NPI:1598789315
Name:DUPUIS, DAVID A (LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:DUPUIS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 WOODWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-1847
Mailing Address - Country:US
Mailing Address - Phone:559-297-6060
Mailing Address - Fax:559-297-6061
Practice Address - Street 1:624 WOODWORTH AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-1847
Practice Address - Country:US
Practice Address - Phone:559-297-6060
Practice Address - Fax:559-297-6061
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS199911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ23823ZMedicare ID - Type Unspecified