Provider Demographics
NPI:1275014417
Name:DUPUIS, DANIEL MARCEL
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:MARCEL
Last Name:DUPUIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 E WALLUM LAKE RD
Mailing Address - Street 2:
Mailing Address - City:PASCOAG
Mailing Address - State:RI
Mailing Address - Zip Code:02859-1809
Mailing Address - Country:US
Mailing Address - Phone:401-721-2718
Mailing Address - Fax:
Practice Address - Street 1:1945 E WALLUM LAKE RD
Practice Address - Street 2:
Practice Address - City:PASCOAG
Practice Address - State:RI
Practice Address - Zip Code:02859-1809
Practice Address - Country:US
Practice Address - Phone:401-721-2718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-26
Last Update Date:2018-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1075761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical