Provider Demographics
NPI:1760790422
Name:DUPELL, RANDY EDWARD (CADC)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:EDWARD
Last Name:DUPELL
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 FRONT ST STE 490
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1742
Mailing Address - Country:US
Mailing Address - Phone:508-799-2934
Mailing Address - Fax:
Practice Address - Street 1:44 FRONT ST STE 490
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1742
Practice Address - Country:US
Practice Address - Phone:508-799-2934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1455AD101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)