Provider Demographics
NPI:1013794510
Name:ALAN DUPONT PSCYHOTHERAPY, LLC
Entity type:Organization
Organization Name:ALAN DUPONT PSCYHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUPONT
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:585-732-5447
Mailing Address - Street 1:49 BARDWELL ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-2589
Mailing Address - Country:US
Mailing Address - Phone:585-732-5447
Mailing Address - Fax:
Practice Address - Street 1:49 BARDWELL ST APT 3
Practice Address - Street 2:
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-2589
Practice Address - Country:US
Practice Address - Phone:585-732-5447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty