Provider Demographics
NPI:1801232871
Name:DUPERVAL, PATRICE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:
Last Name:DUPERVAL
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21770 FDR BLVD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20653-1558
Mailing Address - Country:US
Mailing Address - Phone:301-863-6661
Mailing Address - Fax:
Practice Address - Street 1:30007 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE HALL
Practice Address - State:MD
Practice Address - Zip Code:20622-3101
Practice Address - Country:US
Practice Address - Phone:301-997-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18164104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD18164OtherMARYLAND STATE LICENSE